Background
Success of peritoneal dialysis depends on the durability of the peritoneal dialysis
catheter, which in turn depends on insertion technique. Catheter-related complications
are among the main reasons for peritoneal dialysis failure. Techniques showing evidence
of improved catheter function include rectus sheath tunnel, selective omentopexy,
and adhesiolysis.
Methods
Single-institution retrospective review of consecutive peritoneal dialysis catheter
insertions was performed between 2004 and 2014. Of 235 procedures, the open technique
was utilized in 63, basic laparoscopy with selective adhesiolysis in 80, and advanced
laparoscopy utilizing rectus sheath tunnel, selective omentopexy, and adhesiolysis
in 92. Primary outcomes included catheter dysfunction, catheter dysfunction-free,
and overall survival.
Results
Mechanical catheter dysfunction occurred in 4 patients (4.4%) in the advanced laparoscopy
group, 14 (17.5%) in the basic laparoscopy group, and 20 (31.8%) in the open group
(P < .01). The advanced laparoscopy group had the highest rate of dysfunction-free and
overall catheter survival. The rectus sheath tunnel was protective independently of
dysfunction free catheter survival. The rate of switch to hemodialysis also was significantly
lower in the advanced laparoscopic group (P = .031).
Conclusion
Advanced laparoscopic peritoneal dialysis catheter insertion using rectus sheath tunnel,
selective omentopexy, and adhesiolysis is associated with decreased catheter dysfunction
rates, improved dysfunction-free and overall catheter survival, and lowest rate of
switch to hemodialysis.
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Article info
Publication history
Published online: August 11, 2016
Accepted:
June 4,
2016
Footnotes
Stephen P. Haggerty, MD, FACS, is a consultant and speaker for Covidien and Medtronic since 2013 and has received honorarium from Bard since 2013.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
