Videolaparoscopy as rescue therapy and placement of peritoneal dialysis catheters: a thirty-two case single centre experience

Abstract

Videolaparoscopy prolongs peritoneal catheter survival by treating directly the causes of malfunction. In patients with preceding abdominal interventions, the PD catheter can be placed safely even in cases necessitating surgical preparation like adhesiolysis.

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

“…Omental wrapping, particularly around the distal portion of the catheter, is another frequent cause of PD catheter malfunction. 1,14 It was responsible in a quarter of our patients. Studies have shown that laparoscopic repositioning and adhesiolysis with/without omentectomy are simple techniques that may prolong catheter survival.…”

“…These include the use of enemas to induce active bowel peristalsis, infusion of urokinase in order to lyse the fibrin clot, forced flushing of the catheter and the use of a metal guidewire or Fogarty catheter to manipulate the catheter. 1 However, these conservative methods are not effective in the long run and failure to restore catheter function requires surgical intervention. Historically, this entailed removal and replacement of the catheter using open surgery.…”

“…2 More recently, laparoscopy has been introduced as an alternative surgical modality to rescue malfunctioning catheters and offers the possibility of replacement under direct vision if indicated. 1,3,4 In this paper, we present our experience from a single centre, comparing the outcomes of open and laparoscopic management of malfunctioning PD catheters.…”

SAGES guidelines for laparoscopic peritoneal dialysis access surgery

“…In addition to requiring extra ports and time to perform, 6-9 % of pelvic sutures erode from the tissues during the short-term resulting in an unacceptable incidence of catheter tip migration [6,7]. On occasion, it has been reported that the anchoring suture held and required a laparoscopic procedure to cut the stitch to permit catheter removal [8].…”

Minilaparotomy Salvage of Malfunctioning Catheters in Peritoneal Dialysis

“…Catheter malfunction develops in 3.9% -13.3% of patients with a Tenckhoff catheter (1,2). Catheter malfunction leads to interruption of PD, and a rescue operation such as fluoroscopy-guided manipulation using correction instruments, or laparoscopy or minilaparotomy is usually required (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The success and malfunction recurrence rates vary between methods because of differences in the procedures.…”