A Laparoscopic Method for Optimal Peritoneal Dialysis Access

Abstract

Both medical benefits to the patient and financial incentives to the health care system exist to increase the use of peritoneal dialysis as renal replacement therapy. Providing long-term peritoneal access free of mechanical dysfunction continues to represent a major challenge to the success of this modality. Variable outcomes result from the lack of standard implantation methodology and failure to address persistent problems associated with current implantation techniques. This prospective case study compared noninfectious procedural complications of three approaches to establish peritoneal dialysis access. The groups consisted of 63 catheters implanted by traditional open dissection, 78 catheters implanted by basic laparoscopy without associated interventions, and 200 catheters implanted by advanced laparoscopic methods including rectus sheath tunneling, selective prophylactic omentopexy, and selective adhesiolysis. Mechanical flow obstruction, the major outcome indicator, followed only 1 of 200 (0.5%) implantation procedures in the advanced group and was significantly better ( P < 0.0001) than the open dissection (17.5%) and basic laparoscopic (12.5%) groups. A low rate of pericannular leaks (1.3–2%) was not different for the three groups. One pericannular hernia occurred in the open group. Catheter mechanical dysfunction attributable to the surgical technique can nearly be eliminated through adjunctive procedures made possible only by a laparoscopic approach.

Laparoscopic‐Assisted Placement of a Peritoneal Dialysis Catheter With Partial Omentectomy and Omentopexy in Dogs: An Experimental Study

“…Laparoscopic or laparoscopic‐assisted techniques allow for direct observation within the peritoneal cavity, detection, and potential treatment of underlying abdominal diseases, and adequate catheter positioning . In comparison to open surgery, laparoscopic placement of the PD catheter offers the advantages of laparoscopic surgery: smaller wounds with less tissue trauma, longer efficacy of the catheter, reduced postoperative pain and a lower infection rate . We evaluated abdominal pain before butorphanol administration.…”

“…The laparoscopic‐assisted technique combines the mini‐approach with intra‐abdominal observation . In people, the principal reported benefits of laparoscopic insertion are accurate placement of the catheter under direct vision, less postoperative pain, less risk of leakage through the wounds, and lower complication rates . Next to infection, which can occur secondary to long‐term dialysis, one of the most frequent complications of PD is obstruction of the catheter by the omentum or by fibrin .…”

Peritoneal Dialysis Catheter Placement Techniques

“…(1). The pubic symphysis has been recommended as a reliable landmark for the ideal location of the catheter tip in the true pelvis [29] and confirmed laparoscopically [30]. Incision and Blunt Dissection: After infiltrating the skin and underlying tissue with 2% lidocaine with epinephrine, a horizontal incision 3-4 cm long is made to expose subcutaneous tissue (obese individuals may need an appropriately longer incision).…”

The future of peritoneal dialysis: PD in 2010 and beyond

“…The most common reasons for transfer to HD continue to be related to catheter problems and infectious complications. In reports from centers where there is a dedicated PD implantation team, catheter‐related problems are minimal and seldom a reason for transfer 43. Unfortunately, this expertise is not available at all centers.…”