Laparoscopic salvage of malfunctioning peritoneal catheters

Amerling, Richard; Maele, Dominique Vande; Spivak, Hadar; Lo, Andrew Y.; White, Paul; Beaton, Howard L.; Rudick, J

doi:10.1007/s004649900336

Cited by 40 publications

(39 citation statements)

References 9 publications

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“…The documented complications include peritonitis, tunnel infections, dialysate leaks, hernias, and hemorrhages (10)(11)(12)(13)(14). In addition, due to the peritoneal punctures, PD may have to be discontinued for a few weeks after laparoscopic surgery and this often requires a temporary transition to hemodialysis while the incisions heal.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopic Manipulation of Peritoneal Dialysis Catheters

Miller

McCormick

Lavoie

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Mechanical failure of the peritoneal dialysis (PD) catheter is an important cause of technique failure. Fluoroscopic guidewire manipulation may be undertaken in an attempt to correct the failure. The purpose of this study was to determine the efficacy of fluoroscopic manipulation of previously embedded PD catheters, the factors associated with successful manipulation, and the complication rate associated with manipulation.Design, setting, participants, & measurements A single-center, retrospective review of 70 consecutive PD patients undergoing fluoroscopic manipulation for mechanical failure of their PD catheter from June 2006 to February 2011 was undertaken. Logistic regression models were developed to determine the variables associated with successful manipulation.Results Of the 70 manipulations, 44 were successful (62.9%). In univariate analysis, catheters located in the pelvis compared with those in the upper abdomen (73.5% versus 42.9%, P=0.01) and catheters that were previously functional compared with those that failed at exteriorization (75.0% versus 46.7%, P=0.04) were more likely to be successfully manipulated. Time embedded, previous hemodialysis, and number of intra-abdominal surgeries were not correlated with likelihood of successful manipulation. In multivariate analysis, catheters located in the pelvis (P=0.01) and those with secondary failure (P=0.01) were more likely to successfully manipulated. Two of the patients developed peritonitis (2.9%), neither requiring cessation of PD.Conclusions Fluoroscopic manipulation is an effective and safe therapy for failed PD catheters that are unresponsive to conservative treatment. Properly positioned catheters and those that were previously functional are more likely to be successfully manipulated.

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Section: Discussionmentioning

confidence: 99%

Fluoroscopic Manipulation of Peritoneal Dialysis Catheters

Miller

McCormick

Lavoie

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Amerling et al [17] reported that the success rate of laparoscopic salvage of malfunctioning peritoneal catheters was 93%. Previously reported success rates of laparoscopic surgery were greater than 80% [11,12].…”

Section: Discussionmentioning

confidence: 99%

Use of Fluoroscopy-Guided Wire Manipulation and/or Laparoscopic Surgery in the Repair of Malfunctioning Peritoneal Dialysis Catheters

et al. 2002

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Background: Peritoneal catheter is the lifeline for the continuous ambulatory peritoneal dialysis (CAPD) patients. Over the years, obstruction or displacement of the CAPD catheter has been one of the common complications of CAPD. Fluoroscopy-guided wire manipulation or laparoscopic surgery has been developed to manage outflow obstruction. We analyzed the catheter outcome of fluoroscopy-guided wire manipulation or laparoscopic surgery to determine the ultimate benefit of these procedures. Methods: From June 1996 to August 2000, catheter complications were manipulated in 24 patients. Eleven (46%) of these patients were initially managed by guide wire under fluoroscopic control. The remaining 13 (54%) patients were manipulated by laparoscopic surgery. A successful outcome was defined as maintained normal peritoneal catheter function at 30 days after the manipulations. Among the catheters manipulated, 18 (75%) were inserted by nephrologist and 6 (25%) by surgeons at the initiation of CAPD. Tenckhoff double-cuff peritoneal catheters were inserted to all patients. Results: The time elapsed between catheter insertion and manipulation varied from 1 to 60 days with a mean of 11 days. The primary causes of catheter malfunction were kinking in 1 case, omental wrapping with adhesions in 9 cases, and catheter displacements in the remaining 14 cases. Thirty-day catheter function was achieved in 50% (12/24) of initial catheter manipulations, with guide wire under fluoroscopic control (46%, 5/11) and laparoscopic surgery (54%, 7/13). Overall success rate of repeated manipulation was 71% (17 of 24). Conclusion: The successful outcome in repairing of the malfunctioning CAPD catheters could be increased by the combination of fluoroscopy-guided wire manipulation and laparoscopic surgery.

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“…Our published reports of over 400 buried PD catheters have shown that this technique is associated with low rates of surgical, mechanical, and infectious complications (3). Over the years, we have noted from time to time asymptomatic peritoneal leukocytosis with negative effluent cultures immediately after exteriorization of a buried catheter.…”

Section: Disclosuresmentioning

confidence: 80%