Comparative Experience of a Simple Technique for Laparoscopic Chronic Ambulatory Peritoneal Dialysis Catheter Placement

Abstract

Background: Chronic ambulatory peritoneal dialysis (CAPD) is now an established technique for renal dialysis. Patients with renal failure cope poorly with major surgery and it is vital that the dialysis catheter tip is sited accurately in the pelvis if long-term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy. Methods: A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2-year period. Results of laparoscopically inserted catheters and those placed at laparotomy were compared. Results: Sixty catheters were inserted, 30 laparoscopically and 30 at laparotomy. The mean operative time was 41 min in the laparoscopic patients and 57 min in the laparotomy patients (P = 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P = 0.00002). There were three minor pen-operative complications in the laparoscopic group and seven peri-operative complications in the laparotomy group, three required reoperation and one resulted in the patient's death. There were no significant differences in the incidence of exit-site infection, catheter blockage, peritonitis, and overall catheter survival, although the laparoscopically placed catheters had been followed up for a shorter period (10 vs 16 months). Conclusions: This laparoscopic technique is safe and effective. Postoperative pain was less than for open placement. Laparoscopically placed catheters had a low incidence of pen-operative complications. Medium-term patency is similar to conventionally placed catheters. This procedure requires no additional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.

Laparoscopic versus open peritoneal dialysis catheter placement

“…Prior, smaller, single-center studies comparing laparoscopic and open techniques of PDC placement have, in general, favored the laparoscopic approach with exit site infection rates between 6-23.8 % compared to 8.7-47. 6 % in the open cohort [31][32][33]. Overall, the reported rates of infection from the NSQIP data are lower in comparison with wound-related complications for both LPDC and OPDC; potentially, the infection rates are more pronounced over time as an outpatient as the catheter is used for peritoneal dialysis.…”

Sedation anesthesia technique for the insertion of laparoscopic fixated peritoneal dialysis catheter using carbondioxide

“…Among these techniques laparoscopic peritoneal dialysis catheter insertion had been reported to be the method of choice with low visceral injury, bleeding, incisional hernia and catheter disfunction risks. [14,15] On the other hand various meta-analysis have shown that all insertion methods have been comparable and there were no significant differences among different methods. [16][17][18] Currently; laparoscopic insertion of the peritoneal dialysis catheter is prefered due to better evaluation of the intraabdominal region, catheter fixation capability and availability of adhesiolysis upon observation.…”

Guidelines for laparoscopic peritoneal dialysis access surgery

“…Two early retrospective studies comparing laparoscopic and open insertion of PD catheters showed a trend toward lower complications and dysfunction with the laparoscopic group, but did not reach statistical significance [117,118] patients using open insertion with 21 laparoscopic insertions in a randomized prospective trial. They found higher incidence of early fluid leak in the laparoscopic group 9.5 vs. 0 % and no difference in mechanical dysfunction.…”