A Practical Approach to Laparoscopic Surgery for Malfunctioning Peritoneal Dialysis Catheters

Abstract

Peritoneal dialysis is widely accepted for the chronic management of end-stage renal disease but is associated with as high as a 70% complication rate including a significant problem with peritoneal dialysis catheter flow obstruction. The application of laparoscopic surgical techniques has revolutionized the surgical approach to peritoneal dialysis catheter-related dysfunction. However, the specific laparoscopic surgical technique varied among the reported literature. This lack of a standard laparoscopic surgical approach to obstructed peritoneal dialysis catheters prompted us to review and compare our specific technique and experience in 17 patients with 10 recent reported series. We specifically examined for insufflation techniques, access port placements and closures, timing postoperatively for reinstituting peritoneal dialysis, wound complications, and overall long-term success rates for peritoneal dialysis catheter salvage.

Correction of Peritoneal Catheter Obstruction Using a Neonatal Bronchoscope

“…This manipulation has shown a high incidence of recurrent malfunction and the need for repeat manipulation (1,2). Laparoscopic salvage offers 62 to 100% success rate and 0 to 39% recurrence (3,4,5) but is invasive. Our bronchoscopic method is non-invasive and provides direct visibility into the PD catheter.…”

The role of laparoscopic surgery in the management of a malfunctioning peritoneal catheter

“…10 The use of laparoscopic surgical techniques in salvaging malfunctioning PD catheters has revolutionised the management of this condition. 11 This technique facilitates the simultaneous identification and correction of problems, which may complicate PD and facilitate early return to dialysis. 8 In contrast, the open surgical technique (ie replacement of the PD catheter) does not allow for a diagnosis of the aetiological factor causing the catheter malfunction and is therefore associated with an increased likelihood of recurrence of the problem, as was demonstrated in our study (success rate of 37.5%).…”

Guidelines for laparoscopic peritoneal dialysis access surgery

“…Numerous techniques have been described for salvage of malfunctioning PD catheters, although not all techniques are applicable in each circumstance [131,[217][218][219][220][221]. The specific cause of the catheter problem and the findings at laparoscopic exploration dictate the corrective action.…”

“…Additional 5 mm working ports are then placed to manipulate the catheter [131,189,191,219,222]. Postoperative leakage of dialysate from port sites has been reported, and this has prompted the preferential use of only 5 mm ports by some authors [220]. In addition, port placement through the linea alba has been implicated in postoperative leakage.…”

“…As a result, placement of all ports in a location off-midline has been advocated [131]. In addition, the fascia should be closed with suture at all 10 mm port sites [220].…”