Outcomes of laparoscopic and open CAPD catheter placement: A single-center experience

Abstract

Background Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement is typically a straightforward surgical procedure performed on chronically ill patients with end-stage renal disease (ESRD). Post-operative outcomes and reoperative rates vary greatly in the medical literature. We report our experience using both minimally invasive and open techniques in placing CAPD catheters and offer our surgical outcomes. Methods This study is an IRB-approved, retrospective review (2005–2018) of all patients undergoing CAPD catheter placement at Mayo Clinic-Rochester. Analysis focused on specific patient outcomes, including early (< 30 days) versus late (≥ 30 days) complication and reoperation rates. Results A total of 173 patients with ESRD (mean ASA score = 3.1) underwent laparoscopic (n = 22) and open (n = 151) CAPD catheter placement (mean follow-up = 309 days; range: 1–3497 days). The total index operation complication rate was 41%. The total index reoperation rate was 37% and was similar in open and laparoscopic approaches. CAPD catheters malfunctioned in 19 patients (11% of total) and each underwent reoperation. CAPD catheter infections occurred in 30 patients (17% of total), and 24 required reoperation; 6 patients were treated successfully with antibiotics. CAPD catheter migrations occurred in 21 patients (12% of total) and all underwent reoperation. Conclusion Although CAPD catheter placements in patients with ESRD are technically easy to accomplish, the long term outcomes suggest as many as one in three patients will struggle with catheter function or infection. This study has led to changes in our technical CAPD catheter placement procedures, as well as the post-operative patient care algorithm.

Surgical early complications of the laparoscopic insertion of peritoneal dialysis catheter: A cross-sectional descriptive two-center study in Ahvaz, southwest of Iran

“…In this study, overall, 24.1% of the patients experienced at least one early complication, which is in line with other studies which have reported the rate of such complications to be between 15% and 37.8%. [2][3][4] By contrast, in García-Cruz et al, none of the patients who underwent laparoscopic peritoneal dialysis catheterization suffered from an early complication of peritoneal dialysis catheter insertion. 5 The most frequent early complication of peritoneal dialysis catheter insertion in our study was mechanical complication (16.7%).…”

“…Displacement and migration of the catheter from the pelvis to other parts of the abdomen is another complication of catheter insertion which was seen in 2.5% of the patients, but it was found to be between 4 and 15% in other studies. 1,4,14 This may be due to the use of a laparoscope to properly insert the catheter in place, in addition to other factors including the use of a low volume of dialysis fluid, the use of heparin after catheter placement, the low-volume changes in the first two weeks after catheterization, and the use of laxatives in patients to avoid constipation regardless of the type of surgical technique.…”

Ultrasound-Guided Modified Seldinger Placement of Tenckhoff Catheters in Pediatric Patients Undergoing Peritoneal Dialysis: Single Center Experience

“…The traditional techniques used for open and laparoscopic insertion of a PD catheter require availability of operating theater time and general anesthesia, which can impede timely catheter insertion and restrict access for patients with significant comorbidities. And laparoscopic catheter placement has been shown to have no superiority to open surgery ( 5 , 6 ). In the present study, we present a modified Seldinger technique for placement of a Tenckhoff PD catheter.…”