Laparoscopic Salvage of Malfunctioning Tenckhoff Catheters

Abstract

Twenty of forty-three (46%) patients required Tenckhoff catheter salvage surgery. The laparoscopic approach enabled us to visualize the cause of malfunction and correct problems without reinsertion of a new catheter, as had been our previous practice.

Guidelines for laparoscopic peritoneal dialysis access surgery

“…Although most series are small, this is consistent across multiple reports [189,219,222,223]. In one series of 40 patients who underwent laparoscopy for malfunctioning catheters, catheter tip migration was seen in 28, ten of which had associated omental adhesions.…”

“…The laparoscope may be introduced through a periumbilical port to diagnose the etiology of the malfunction. 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].…”

“…If fibrin plugging is present, the catheter may be stripped with blunt grasping instruments. If this does not work, the tip of the catheter can be exteriorized through one of the port sites to facilitate clearing [220,222]. The catheter tip is then replaced into a proper dependent position within the pelvis.…”

Laparoscopic versus open peritoneal dialysis catheter placement

“…The goal was safe and effective long-term use of the catheter with the avoidance of complications such as peritonitis and bowel perforation found in percutaneous or peritoneoscopic placement [3,4]. Since the 1970s, failure of PDCs occurred up to 70 % of patients within the first year of placement [5][6][7][8][9][10][11][12][13][14][15]. Early pioneers in laparoscopy applied peritoneoscopy as visualization through the percutaneous access site for salvage procedures; over time, laparoscopic salvage techniques for nonfunctioning catheters became more refined, allowing for PDC retrieval, adhesiolysis, catheter tip fixation, as well as omental manipulation, including omentectomy as necessary [5][6][7][8][9][10][11][12][13][14][15].…”

“…Since the 1970s, failure of PDCs occurred up to 70 % of patients within the first year of placement [5][6][7][8][9][10][11][12][13][14][15]. Early pioneers in laparoscopy applied peritoneoscopy as visualization through the percutaneous access site for salvage procedures; over time, laparoscopic salvage techniques for nonfunctioning catheters became more refined, allowing for PDC retrieval, adhesiolysis, catheter tip fixation, as well as omental manipulation, including omentectomy as necessary [5][6][7][8][9][10][11][12][13][14][15]. Initial placement of PDCs laparoscopically was first described in case series in 1990s [16][17][18][19][20][21][22][23].…”