Evaluation of Laparoscopic-assisted insertion of the peritoneal dialysis catheter in high-risk cases

Abstract

Background and Aims: More than 100,000 patients (15% of the population) of end-stage renal disease (ESRD) are treated by peritoneal dialysis (PD) globally. Methods: Patients with ESRD requiring renal transplant, were referred to the author for inserting the PDC. The patients were fit for general anesthesia with an average of 2.4 anesthetic risk score. The standard double-port laparoscopy used to treat most of the patients. Additional port(s) were used in case of previous surgery, abdominal disease, or redundant omentum. Rectus sheath tunneling and catheter insertion were accomplished under laparoscopic visualization. The demographic, operative and post¬operative outcomes were analyzed by SPSS-19. Results: The mean age was 46 years. The average body mass index (± SD) was 31.5 ± 6.6 kg/m2. The surgical risk was reported as abdominal surgery in 7 cases, pelvic surgery in 10 cases, and abdominopelvic infections in 6 cases. In 25 out of 31 patients (80.6%), the laparoscopic technique was implemented via the recommended double ports. After the management of these complications, a final twenty-nine patients (93.5%) were still maintained on PD. Two (6.4%) cases had peritonitis; the catheters were removed and the cases were shifted to hemodialysis. Conclusions: The LA-PDC insertion was a good and easy approach. It minimized surgical trauma, allowed accurate pelvic catheter positioning and provided a visualized access to handle the omentum and existing adhesions. It was associated with a few catheter-related complications that were easily treated. Long term compliance was excellent.

References

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