Video-assisted laparoscopic procedures in peritoneal dialysis

S C Jwo, K S Chen, Y Y Lin
Surgical Endoscopy 2003, 17 (10): 1666-70

BACKGROUND: Although laparoscopy is commonly adopted for the diagnosis and management of various medical or surgical problems, its use for patients with peritoneal dialysis has seldom been addressed. This retrospective study analyzes the indications and clinical effects of this procedure.

METHODS: A retrospective chart was drawn up and a videotape review performed for 18 laparoscopic procedures involving 198 patients receiving peritoneal dialysis on a long-term basis at our dialysis unit from May 1992 to June 2002. The clinical and demographic parameters in this study included gender, age, underlying renal diseases, duration of peritoneal dialysis before laparoscopy, indications of laparoscopic intervention, laparoscopic findings, time of operation, laparoscopic procedures, postoperative complications, mortality, and catheter results.

RESULTS: A total of 18 laparoscopic procedures were performed in 17 uremia patients, with indications including catheter malfunction in five cases, preimplantation evaluation of peritoneal space in three cases, evaluation of the etiology underlying intractable peritonitis in nine cases, and verification of the cause for dialysate leakage in one case. Four (80%) of the five catheter malfunctions were successfully corrected, including one case of catheter migration and three cases of omental wrapping, whereas correction failed in the remaining case because of severe bowel adhesion. New catheter placement after adhesiolysis was successful in all three cases of preimplantation peritoneal evaluation (100%). Of the nine patients whose peritonitis episodes were evaluated, two were found to have secondary peritonitis, two had fungal peritonitis; one had tuberculous peritonitis and four had bacterial peritonitis. In the case of persistent exit-site dialysate leakage, laparoscopy showed a penetrating injury of the abdominal wall, raising a strong suspicion of iatrogenic injury during the tunneling maneuvers in initial catheter placement. Two conversions to laparotomy were performed: one to repair the penetrating injury and the other to save the life of a patient threatened by severe fungal peritonitis with abdominal cocoon formation. The laparoscopic procedures lasted 20 to 150 min (average, 50 min). Despite one instance of postoperative hydrocele, there was no operative mortality.

CONCLUSIONS: The analytical results of this study demonstrate that the current video-assisted laparoscopic technique is an effective means for managing several problems related to peritoneal dialysis such as catheter malfunction, preimplantation evaluation, location of the source of the dialysate leak, and assessment of the causes for peritonitis. Thus, this technique should always be considered when the these problems arise.

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