Peritoneal Dialysis Catheter Emplacement by Advanced Laparoscopy: 8-year Experience from a Medical Center of China

Abstract

Laparoscopic experience and relevant reports about PD catheter emplacement in Chinese patients are seldom. In this study, we described our experience with advanced laparoscopy for PD catheter implantation in Chinese patients. There were one hundred and thirty Chinese patients accepted advanced laparoscopic approach for PD catheter emplacement in this study. Six of 26 patients with prior abdominal operations had abdominal adhesion, while six of 104 patients without prior abdominal surgeries showed abdominal adhesion. Operation time required 10 to 180 minutes. During a mean follow-up time of 26.46 months, the catheter complications were shown as outflow obstruction (n = 6, 4.62%), pericatheter leaking (n = 3, 2.31%), hydrocele of tunica vaginalis (n = 1, 0.77% in all), and umbilical hernia (n = 2, 1.54%). Cumulative revision-free survival probability for catheter loss from mechanical complications at 8 years was 0.95. During the postoperative follow-up ranged between 6 and 106 months, 98 patients (75.38%) were still on CAPD, 17 patients (13.08%) died, 8 patients (6.15%) were transferred to hemodialysis, 6 patients (4.62%) received kidney transplantation, and 1 patient (0.77%) showed improved renal function. These results showed that PD catheter placement with advanced laparoscopy is a safe and effective approach in Chinese patients with or without prior abdominal surgeries.

Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update

“…However, the effect of infectious complications on catheter survival beyond 30 days is more likely due to causes unrelated to the insertion procedure per se. The few studies that provide data according to the above definition for 12-month catheter patency support a benchmark value of > 80% patency for conventional methods and > 95% for advanced laparoscopic procedures (43,57,61,62).…”

“…Surgical laparoscopy uses either a basic or advanced approach to providing PD access. Basic laparoscopic catheter placement has come to mean using the laparoscope to simply monitor the positioning of the catheter tip within the peritoneal cavity (44,56), whereas advanced laparoscopic implantation utilizes additional preemptive procedures to minimize subsequent risk of mechanical catheter complications (57 58 59 60 61-62). With either approach, a pneumoperitoneum is created by insufflating gas through a lateral abdominal wall puncture site using a Veress needle or optical trocar device distant from the point of intended catheter insertion.…”

“…Other variations of rectus sheath tunneling, including the use of a third laparoscopic port site, have been described but the effect is the same, with immobilization of the catheter in a craniocaudal direction through the rectus sheath toward the pelvis (58,60,62). Alternatively, immobilization of the catheter toward the pelvis has been accomplished with a suture sling placed around the tubing through the lower abdominal wall (67).…”

“…Advanced laparoscopic catheter placement employs proactive adjunctive techniques that significantly improve catheter outcomes. Laparoscopically guided tunneling of a port device through the rectus sheath permits placement of the catheter in a long musculofascial tunnel directed toward the pelvis and effectively prevents catheter tip migration, eliminates pericatheter hernias, and reduces the risk of pericatheter leaks (57)(58)(59)(60)(61)(62). Observed redundant omentum that lies in juxtaposition of the catheter tip can be displaced from the pelvis into the upper abdomen and fixed to the abdominal wall or falciform ligament, or folded upon itself (omentopexy) (43,63,64).…”

A Simple Tenckhoff Catheter Placement Technique for Continuous Ambulatory Peritoneal Dialysis (CAPD) Using the Bandung Method

“…is rate is low in comparison with other studies [21,22]. e bleeding rate using the Bandung method is similar with advanced laparoscopy [23]. Outflow obstruction is a common cause of peritoneal dialysis catheter malfunction.…”