Laparoscopic Tenckhoff Catheter Implantation in Children

Abstract

Objective To assess the suitability of a laparoscopic Tenckhoff catheter implantation (TCI) technique in children. Design Prospective nonrandomized controlled study. Setting Laparoscopic and conventional TCIs in children were performed in a tertiary-care hospital. Patients Between 1998 and 2001, 25 laparoscopic and 23 conventional TCIs were performed in 42 children. Patients in unstable clinical conditions were excluded. The laparoscope was inserted via transumbilical incision, and a forceps by percutaneous puncture. After catheter insertion, the tip was positioned in the Douglas space, and the inner cuff placed adjacent to the peritoneum, without sutures. Peritoneal dialysis was initiated immediately after surgery. Main Outcome Measures Catheter-related complications during the first 4 weeks after TCI. Results After laparoscopic TCI, dialysate leakage occurred in 2 of 25 cases, one of which could be managed conservatively. In 1 patient in whom dwell volume was increased immediately after laparoscopic TCI, subcutaneous leakage occurred at the site of forceps insertion. In 2 patients with severe pre-existing intra-abdominal adhesions, outflow obstruction persisted after laparoscopic TCI. Simultaneous herniotomy was performed in 2 male infants. After conventional TCI, dialysate leakage occurred in 5 of 23 cases, 1 of which could be managed conservatively. Outflow obstruction occurred in 2 cases. Conclusion Laparoscopic TCI is feasible in children of all age groups, with at least equivalent functional results compared to conventional TCI. An additional advantage is the option to identify and eliminate anatomical risk factors, such as intra-abdominal adhesions or preformed inguinal hernias in male infants.

Laparoscopic versus open catheter placement in peritoneal dialysis patients: a systematic review and meta-analysis

“…It provided the patient reduced perioperative discomfort and earlier return to full mobility [ 14 ]. It also allowed the diagnosis and treatment of the accompanying surgical pathologies during the same operation, such as intra-abdominal adhesions or preformed inguinal hernias [ 11 , 12 ]. Compared to traditional peritoneal dialysis catheter placement, laparoscopic catheter placement has smaller scar, less pain, and quicker recovery.…”

“…The heterogeneity of the dialysate leaks, and blockage might due to the operations by different surgeons, the different study designs, catheter types, and operation techniques. What is more, patients in one of the observational study were children [ 12 ], and it would affect the stability of results. In order to reduce the heterogeneity, we conducted a further research, and made subgroup analysis, but got the same conclusion.…”

Chronic peritoneal dialysis in children

“…In addition, the smaller diameter of the peritoneal perforation produced by the peel-away sheath and elastic sealing of the insertion site may be advantageous. 24 Other procedures may also be performed laparoscopically at the same sitting such as nephrectomy, gastrostomy insertion, and herniotomy. In our experience, children who undergo simultaneous laparoscopic PD catheter and gastrostomy insertion do not have an increased incidence of catheterrelated peritonitis.…”

“…Some surgeons close the internal ring (thereby preventing clinical hernia) if it is found to be open during laparoscopic PD catheter placement. 24,59 encapsulating peritoneal sclerosis…”

Laparoscopic peritoneal dialysis catheter implantations

“…Sürekli ayaktan periton diyalizi (SAPD), kronik böbrek yetmezlikli hastalarda tercih edilen tedavi seçeneklerinden biridir (1,2) . SAPD işleminin yapılabilmesi için periton boşluğuna güvenilir sıvı alış verişini sağlayacak kalıcı bir kateter yerleştirilmesi gerekmektedir.…”