Revision Techniques for Failed PD Catheters: Outcome in a University Hospital

Peppelenbosch, A.G.; Laanen, Jorinde van; Cornelis, T.; Graaf, Rick de; Mees, Barend; Tordoir, Jan H.M.

doi:10.5301/jva.5000374

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…However, because of the small numbers we could not observe a trend in this difference (3/6 of patients, 50% in the open surgery group versus 11/16 of patients, 69% in the laparoscopic group; p = 0.62). As previously described by our group, when revision techniques were used, we could increase the overall rate of adequate functioning catheters up to 90% in both groups (15).…”

Section: Resultsmentioning

confidence: 53%

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Randomized Controlled Trial Comparing Open versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The Capd I Trial

et al. 2017

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Section: Resultsmentioning

confidence: 53%

“…This technique can be time-consuming and was done in an interventional radiologic suite. If this failed, surgical techniques were used to improve the position and thus enhance function of the catheter, such as omentectomy and fixation of the catheter, as has earlier been described by our group (15).…”

Section: Methodsmentioning

confidence: 99%

Randomized Controlled Trial Comparing Open versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The Capd I Trial

et al. 2017

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“…Laparoscopic insertion and omentectomy are more often recommended as a salvage procedure for blocked PD catheters. [ 10 13 14 15 ] A purported advantage of laparoscopic PDCI (in addition to facilitating omentectomy through small incisions) is that it also facilitates lysis of intraperitoneal adhesions. Patients who have had previous abdominal surgery or PD peritonitis are more prone to adhesion formation.…”

Section: Discussionmentioning

confidence: 99%

Does laparoscopic omentectomy reduce CAPD catheter malfunction: A three-arm pilot randomized trial

et al. 2022

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Introduction: Catheter malfunction secondary to omental wrapping is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). Of the various methods of peritoneal dialysis catheter insertion (PDCI), open surgical insertion under local anesthesia is most widely practiced. Laparoscopic omentectomy is often undertaken as a salvage procedure in case of malfunctioning catheters. However, there is no randomized controlled trial (RCT) to evaluate the role of prophylactic laparoscopic omentectomy on catheter function. This pilot RCT was undertaken to evaluate the impact of laparoscopic omentectomy on the incidence of catheter malfunction. Materials and Methods: Consecutive patients were randomized into three groups: laparoscopic PDCI with omentectomy (Group A), laparoscopic PDCI without omentectomy (Group B) and open surgical PDCI (Group C). The primary outcome was the incidence of catheter malfunction at 6 weeks and 3 months. Results: Forty-one patients completed follow-up, with 16, 11, and 14 patients in Groups A, B, and C, respectively. Incidence of catheter malfunction was 6.2%, 27.3%, and 14.3% in Groups A, B, and C, respectively, at 6 weeks and 6.2%, 36.4%, and 21.4% at 3 months, respectively. In patients with previously failed catheter insertion ( n = 23), malfunction at 3 months was 8.3% (1/12) in patients who had omentectomy, compared with 45.5% (5/11) in those who did not ( P = 0.069). Operating time was significantly higher ( P < 0.001) in Group A. Conclusions: Laparoscopic omentectomy may be associated with a lower incidence of catheter malfunction, especially in patients with previously failed peritoneal dialysis catheter. Data from this pilot RCT can be used to design a large trial with an adequate number of patients.

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“…After scrutinizing literature, we concluded that omental removal might improve our outcome, since omental wrapping causes most catheter failures. Also in our previous publication, we proved removal of the omentum to be successful; however, this is a challenging procedure [ 3 ]. Fixation of the omentum has been shown to be a safe and feasible alternative to prevent omental wrapping [ 9 – 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Post-operative complications can be obstruction of flow through the catheter, catheter migration, fluid leaks, erosion of catheter into viscera, and sclerosing or bacterial peritonitis [ 1 ]. Various causes for catheter obstruction are identified such as omental wrapping, adhesions, and catheter migration [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Introduction of advanced laparoscopy for peritoneal dialysis catheter placement and the outcome in a University Hospital

et al. 2021

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Background Peritoneal dialysis (PD) catheters can be obstructed by omental wrapping or migration, leading to catheter malfunction. Multiple catheter placement techniques have been described. Advanced laparoscopy with fixation of the catheter and omentum has been reported to improve functional outcome compared to basic laparoscopy without fixation. This feasibility study describes surgical technique, complications, and comparison of the functional outcome of advanced versus basic laparoscopic catheter placement. Methods Between July 2016 and April 2019, the advanced laparoscopy technique was applied in all eligible patients. Two experienced surgeons placed the catheters in a standardized procedure. Peri-operative complications and functional outcome of the catheter were scored. Results were compared to a historical cohort retrieved from our RCT performed earlier using basic laparoscopy. Findings The basic laparoscopic group (BLG) consisted of 46 patients and the advanced laparoscopic group (ALG) of 32. Complication rate in both groups was similar and low with 7% in the BLG and 6% in the ALG (p = 1.0). There was a trend toward better functional catheter outcome in the ALG (88%) compared to the BLG (70%) (p = 0.1). Part of the catheter failures in the ALG could be related to the learning curve. After revision surgery, 94% of patients in the ALG had a functional catheter. These findings lead to the set-up of a multi-center randomized-controlled trial, currently running, comparing basic to advanced laparoscopic techniques.

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Revision Techniques for Failed PD Catheters: Outcome in a University Hospital

Abstract: The salvage of the catheter by means of a laparoscopic procedure or correction of a hernia is worthwhile and can save up to 81% of the catheters.

Cited by 5 publications

References 4 publications

Randomized Controlled Trial Comparing Open versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The Capd I Trial

Randomized Controlled Trial Comparing Open versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The Capd I Trial

Does laparoscopic omentectomy reduce CAPD catheter malfunction: A three-arm pilot randomized trial

Introduction of advanced laparoscopy for peritoneal dialysis catheter placement and the outcome in a University Hospital

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