COMPARATIVE STUDY
JOURNAL ARTICLE

Laparoscopic implantation of the Tenckhoff catheter for the treatment of end-stage renal failure and congestive heart failure: experience with the pelvic fixation technique

Dan Bar-Zohar, Boaz Sagie, Nir Lubezky, Miriam Blum, Joseph Klausner, Subhi Abu-Abeid
Israel Medical Association Journal: IMAJ 2006, 8 (3): 174-8
16599052

BACKGROUND: Peritoneal dialysis is a widely accepted route for renal replacement. With the advent of endoscopy, many surgical techniques for the prevention of catheter failure have been proposed.

OBJECTIVES: To evaluate the outcomes of patients undergoing laparoscopic Tenckhoff catheter implantation using the pelvic fixation technique.

METHODS: Data analysis was retrospective. All procedures were performed under general anesthesia. A double-cuffed catheter was inserted using two 5 mm trocars and one 10 mm trocar, fixing its internal tip to the dome of the bladder and its inner cuff to the fascia. Catheter failure was defined as persistent peritonitis/exit-site/tunnel infection, severe dialysate leak, migration or outflow obstruction.

RESULTS: LTCI was performed in 34 patients. Mean patient age was 65 +/- 17 years. In 12 of the 34 patients the indication for LTCI was end-stage renal failure combined with NYHA class IV congestive heart failure. Operative time was 35 +/- 15 minutes. A previous laparotomy was performed in 9 patients. Hospital stay was 1.5 +/- 0.6 days. The first continuous ambulatory peritoneal dialysis was performed after 20 +/- 12 days. Median follow-up time was 13 months. There were several complications, including 5 (14%) exit-site/tunnel infections, 27 episodes (0.05 per patient-month) of bacterial peritonitis, 3 (9%) incisional hernias, 1 case of fatal intraabdominal bleeding, 2 (5.8%) catheter migrations (functionally significant), and 10 (30%) cases of catheter plugging, 8 of which were treated successfully by instillation of urokinase and 2 surgically. A complication-mandated surgery was performed in 8 patients (23.5%). The 1 year failure-free rate of the catheter was 80.8%. One fatal intraabdominal bleeding was recorded.

CONCLUSIONS: LTCI is safe, obviating the need for laparotomy in high risk patients. Catheter fixation to the bladder may prevent common mechanical failures.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
16599052
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"