Malfunctioning Peritoneal Dialysis Catheter and Accompanying Surgical Pathology Repaired by Laparoscopic Surgery

Abstract

♦ Objectives To review the laparoscopic salvaging of malfunctioning peritoneal dialysis (PD) catheters, and to present our experience with laparoscopic repair of dysfunctional Tenckhoff catheters and the treatment of accompanying surgical pathologies. ♦ Design Malfunctioning peritoneal catheters were repaired using laparoscopic rescue techniques. Accompanying surgical problems were treated in the same operation. The effectiveness of these approaches was validated by comparison with other remedial techniques described previously. ♦ Patients Malfunctioning PD catheters were salvaged by laparoscopic surgery in 8 patients, and accompanying surgical problems were treated in the same operation in 3 of the 8 patients. ♦ Main Outcome Measures Outcome was measured by the successful return to adequate PD and effective treatment of surgical problems. ♦ Results Eight patient studies show laparoscopic correction of malfunctioning catheters and the treatment of accompanying surgical pathologies with the return to successful PD. ♦ Conclusion The salvaging of malfunctioning PD catheters by laparoscopic surgery is an ideal method. This procedure permits simultaneous identification and correction of other surgical problems that could otherwise complicate dialysis therapy.

Minimally invasive surgery for salvage of malfunctioning peritoneal dialysis catheters

“…Omental wrapping is another common cause of catheter malfunction and incidence as high as 32% has been suggested. [ 9 ] In our series, it occurred in 9/18 patients. It has been suggested that as the adhesions above the level of pelvis do not interfere with catheter function, extensive adhesiolysis is not necessary.…”

Minilaparotomy for malfunctioning peritoneal dialysis catheter by nephrologists: experiences at two centers

“…One patient had a high BMI (30.4 kg/m 2 ) and diabetes mellitus, so the period of PD interruption was set at 2 weeks. Physiological adverse effects due to CO 2 pneumoperitoneum are also disadvantages for laparoscopic surgery [19]. Leung et al performed laparoscopic salvages of the obstructed catheter and reported that the operation time was 45 to 75 min [20].…”

A Novel Technique for Laparoscopic Salvage of CAPD Catheter Malfunction and Migration: The Santosh-PGI Hanging Loop Technique

“…Appendices epiploicae has been rarely reported as a cause of catheter occlusion [ 3 ]. CAPD catheter salvage instead of removal helps in functional rescue, thereby prolonging catheter life, decreasing patient morbidity, reducing financial burden, and allowing early institution of peritoneal dialysis, thereby decreasing dependence on intermediary hemodialysis [ 8 ]. Laparoscopic salvage of CAPD catheters has several reported advantages [ 8 ].…”

“…CAPD catheter salvage instead of removal helps in functional rescue, thereby prolonging catheter life, decreasing patient morbidity, reducing financial burden, and allowing early institution of peritoneal dialysis, thereby decreasing dependence on intermediary hemodialysis [ 8 ]. Laparoscopic salvage of CAPD catheters has several reported advantages [ 8 ]. Laparoscopy provides a direct vision of the pathology, helps in diagnosis of other intra-abdominal pathologies, has lower incidence of postsurgical adhesions, incision related complications, postprocedure pain, thereby resulting in early ambulation, shorter hospital stay with quicker return to work.…”

“…Laparoscopically salvaged catheters have been shown to have reasonably good period of catheter survival with a median of 163 days in some studies [ 7 ]. Initial success rates of as high as 100% have been reported [ 8 ] highlighting the usefulness of salvage procedures.…”