Laparoscopic-assisted peritoneal dialysis catheter implantation in pediatric patients.

OBJECTIVES: To assess the feasibility and complications of laparoscopic-assisted placement of peritoneal dialysis catheters (PDCs) in pediatric patients.

METHODS: A total of 15 patients undergoing laparoscopic-assisted PDC insertion were studied. A single 10-mm epigastric port was used, unless concomitant diseases were present. A double-cuffed straight Tenckhoff catheter was implanted, with the deep cuff placed within a preperitoneal tunnel underneath the left rectus muscle. The catheter tip was positioned in the left iliac fossa by stylet wire manipulation under laparoscopic control, with the exit site oriented laterally or downward. Subtotal omentectomy was performed by way of the epigastric port site. The findings were compared with those of a group of patients undergoing open PDC insertion.

RESULTS: The median operating time was not different in the two groups. In the laparoscopic group, a single port was used in 9 cases, and adhesiolysis was performed in 2. The median time to PD initiation was not different in the two groups, nor were any significant differences found in the infectious complications, leak or obstruction rates, or need for secondary surgical revisions between the two groups. Surgical revision was necessary because of peritonitis in 1, persistent leak in 1, and dislodgement in 2 in the open group and because of blockages in 3 in the laparoscopic group. Laparoscopy allowed for the rescue of two such catheters.

CONCLUSIONS: The results of our study have shown that laparoscopy allows for careful assessment of the abdominal cavity, recognition and treatment of intraabdominal diseases, and precise placement of PDCs. However, it does not seem to reduce the early catheter-related complication rate. Mechanical obstruction remains a common cause of early catheter malfunction. However, laparoscopy can allow for the rescue of blocked catheters.