July 2009

Feasibility and Efficacy of Optimal Peritoneal Dialysis Catheter Placement Using a Laparoscopic Technique

Introduction or Purpose

Peritoneal dialysis (PD) is an effective and accepted method for renal replacement therapy in patients with chronic renal failure. Various laparoscopic techniques have been described separately to optimize placement and reduce the potential of catheter related complications and failure. A study was undertaken to determine the feasibility and efficacy of combining these laparoscopic techniques for optimal placement of PD catheters.

Materials and Methods

Results or Accomplishments

Discussion or Conclusions

Ghazal Khandel BS; Adrian G. Dan MD; Rachelle Scharsu RN,BSN; John Zografakis MD, FACSAKRON CITY HOSPITAL- SUMMA HEALTH SYSTEM

NORTHEASTERN OHIO UNIVERSTIES COLLEGE OF MEDICINEP#24

A retrospective chart review of 43 laparoscopic PD catheter placement was reviewed from August 2007 to August 2008. This technique includes the placement of an adhesive betadine impregnated drape and betadine catheter site irrigation to avoid infection, the use of fascia and muscle separating trocars to avoid hernia formation, omentopexy to the right upper quadrant using trans-abdominal suture passers to avoid omental wrapping, pre-peritoneal catheter tunneling under laparoscopic guidance, suture anchoring to the anterior abdominal wall to avoid catheter migration and flushing with heparinized saline at the end of the procedure to avoid fibrin clotting.The patients were contacted by phone and were questioned regarding their experience with the catheter, and if they have had any problem such as infection, clotting, etc. whether or not the catheter was revised, was the catheter removed, and if so why, and whether or not the patient is on the list for kidney transplant.

Laparoscopic PD catheter placement was attempted in 43 patients, all with an ASA of 3 or 4, with a mean age of 55.14 years (M:F=31:12). Catheter placement was successful in 93% (40/43) of patients and was aborted in 3 patients (7%) with extensive intra-abdominal adhesions (mean of surgery =32.25 min). The procedure was performed as an outpatient in 91% (39/43) of patients and 4.5% (2/43) stayed for 23-hour observation and 4.5% (2/43) stayed for in-house consult. The mortality rate was 0% and the 30-day morbidity was17.5% (7/40) and included 2 catheter not functioning, 1 intra-abdominal hemorrhage, 1 fungal infection and 3 which needed to be revised. The total of 6 catheters were removed including 2 non-functioning, 1 fungal infection, 1 intra-abdominal hemorrhage, and 2 who wished to switch to hemodialysis and 1 due to no need after successful renal transplantation.

30 catheters reported

no malfunction

3 catheters removed

- 2 switched to HD

- 1 kidney transplant

33 patients

no short-term

problem

(82.5)

4 catheters removed

-2 nonfunctioning

-1 fungal infection

- 1 intraabdominal hemorraheg

3 catheters revised

7 patients

short-term failure

(17.5%)

40 patients

Successful

(93%)

3 patients

Unsuccessful

(7%)

Total of 43 patients

Optimal placement of PD catheter using a combination of laparoscopic techniques is highly feasible (93%) and efficacious with acceptably low short term catheter complication and failure rates, comparing favorably with reported rates for the standard open technique.

Figure 2: Omentopexy

Figure 3: Figure 4: Abdominal wall anchoring with prolene suture

Figure 1: Omentopexy

Introduction to CAPD catheter