Effects of a Novel Peritoneal Dialysis: The Open Versus Laparoscopic Preperitoneal Tunneling Technique

Abstract

The key to achieving adequate continuous ambulatory peritoneal dialysis (CAPD) is that a functioning catheter should enable unrestricted inflow and outflow of the dialysate liquid from the peritoneal cavity with an intact peritoneal membrane. Despite its advantages, complications, such as outflow obstruction, catheter-related infection, and dialysate leakage are still problematic. Various laparoscopic techniques for catheter placement have been investigated. The main purpose of this study was to compare the laparoscopic and open surgical peritoneal dialysis (PD) catheter insertion techniques in a retrospective manner according to catheter survival, complications and the safety of both techniques. The study included end stage renal disease patients in our hospital in whom a PD catheter was placed between 2007 and 2014. Patients were divided into two groups: the open technique (OT) group and the laparoscopic preperitoneal tunneling approach (LA) group. Extracted data included patient demographics, operative data, catheter-related complications and follow-up data. Sixty-nine patients were enrolled into the study. CAPD catheters were placed into 35 patients via LA and 34 via OT. We found that the LA group patients had better survival rates compared with the OT group, especially the long-term survivals. All of the CAPD-related complications, (peritonitis, malposition, outflow obstruction, leakage) were lower in the LA group. However, the peritonitis, malposition and groin hernia rates were also statistically significantly lower in the LA group. When compared with the published data, we recommend laparoscopic CAPD catheter placement with a preperitoneal tunneling technique. The technique is safe and offers a better outcome.

Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis

“…Catheter survival: The 1-year ( Figure 2G) (15,16,18) and 2-year ( Figure 2H) (16,18) catheter survival rates were better in the advanced laparoscopy group. …”

“…Catheter Figure 2B). The incidence of pericannular leak was reported in 5 studies (3,15,16,18,19), including 668 patients, and their metaanalysis significantly favored the advanced laparoscopy group ( Figure 2C). …”

“…With NOS criteria, the cohort studies scored an average of 6.3 points, indicating medium quality (3,(15)(16)(17)(18)(19)(20).…”

“…Infections: Three studies that investigated the incidence of peritonitis after PD catheter insertion were included in the meta-analysis, with a total of 326 patients (15,16,18). There was no statistically significant difference in the risk of developing peritonitis between the groups ( Figure 2E).…”

Pericatheter Hernia of Peritoneal Dialysis, Leading to Acute Bowel Obstruction

“…Peritoneal dialysis (PD) has been a reliable alternative treatment for end-stage chronic renal disease (ESRD) since 1976 [1]. Approximately, 10% to 15% of patients with ESRD are on PD worldwide.…”