The role of laparoscopic surgery in the management of a malfunctioning peritoneal catheter

Abstract

INTRODUCTION Peritoneal catheter malfunction is a common complication of peritoneal dialysis (PD). It has a high failure rate with conservative management. Catheter replacement was historically the standard surgical treatment of choice. Nowadays, laparoscopy has been introduced as an alternative surgical modality to rescue the malfunctioning peritoneal catheter and also offers the possibility of replacement if indicated. The aim of this study was to compare the outcomes of these two surgical modalities. METHODS The medical records of consecutive patients who underwent surgical treatment for malfunctioning PD catheters (between January 2010 and April 2013) were analysed. The primary outcome included successful return to adequate PD. The secondary endpoint was length of catheter patency and the cause of catheter failure. RESULTS A total of 32 cases were identified, of which 8 had open catheter replacement and 24 had a laparoscopic intervention. The overall median follow-up duration was 12.5 months. The success rate for laparoscopic surgery in terms of functioning catheter at 12 months was 62.5% but only 37.5% for open surgery. The mean length of catheter patency after laparoscopic intervention was 31.6 months compared with only 13.6 months for the open surgery group. The most common cause of catheter failure diagnosed during laparoscopic intervention was catheter migration (33.0%), followed by omental wrap and catheter blockage by fibrin/blood plug (25.0% each). Open surgery did not have any diagnostic potential. CONCLUSIONS Laparoscopy is the treatment of choice for malfunctioning PD. Its proven benefit includes simultaneous identification of the aetiological cause of malfunction together with direct correction of this problem, thereby maximising outcome. It also allows for rapid recommencement of PD and avoidance of haemodialysis, saving cost and resources.

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

“…Laparoscopy has the advantage of allowing identification of the underlying condition producing catheter flow dysfunction, permitting diagnosis-specific management. Laparoscopically enabled interventions have produced long-term clinical success in 63% -100% of cases (43,61,87,(181)(182)(183)(184). For this reason, laparoscopic rescue is often considered the next step in the management sequence for catheter flow dysfunction after the diagnosis of constipation, bladder distention, and fibrin plug have been excluded.…”

An Indigenous Method of Securing Ventriculoperitoneal Shunt Tube in Peritoneal Cavity

“…This is due to epithelial response to the presence of catheter and omentum plugs on the shunt tube. 1,2 The abdominal end of the catheter is usually inserted by a small laparotomy, placing the shunt tube in the direction of right iliac fossa. This is a blind procedure.…”

“…It also comes very handy in revision shunt surgeries and has slowly been becoming the standard wherever feasible. 2,3 A common complication which occurs with peritoneal dialysis (PD) catheters is omental wrap, which means the advancement of omentum toward and blocking the catheter. 3…”

Laparoscopy for continuous ambulatory peritoneal dialysis catheter placement and management of malfunctioning peritoneal dialysis catheter

“…Most problems such as catheter migration, malpositioning of the catheter tip and obstruction secondary to fibrin deposition, omental wrapping or intraperitoneal adhesions can be salvaged by laparoscopy. [ 8 ] Catheter survival rate of 60%–90% at 1 year can be achieved after laparoscopy salvage. [ 8 9 10 ]…”

“…[ 8 ] Catheter survival rate of 60%–90% at 1 year can be achieved after laparoscopy salvage. [ 8 9 10 ]…”