Does previous abdominal operation affect peritoneal dialysis complications and outcomes?

OBJECTIVE: Peritoneal dialysis (PD) "First Policy" for end stage renal disease (ESRD) patients who are under universal healthcare coverage scheme, was implemented in Thailand since January 2008. Now there are about 10,000 PD patients all over the country and most of them are in low to medium socio-economic status. In the past, previous abdominal operation was considered as a contra-indication to PD. The purpose of the present study is to compare the complications and outcomes between patients with and without previous abdominal operation.

MATERIAL AND METHOD: The present study was a retrospective review of all new PD cases for complications and outcome of the first PD catheter implantation. The method of catheter implantation is mini-laparotomy under local anesthesia by one surgeon. The bleeding, exit site/wound infection, catheter malposition/obstruction, and catheter/technique/patient survival rate were compared between two groups.

RESULTS: In 730 ESRD patients who underwent catheter implantation, there were 106 patients with history of previous abdominal operation (14.5%). There were no significant differences between patients "with previous abdominal operation" and "without previous abdominal operation", for bleeding, exit site/wound infection, catheter malposition/obstruction, and catheter/technique/patient survival.

CONCLUSION: History of previous abdominal operation in ESRD patients is not a contra-indication to PD. The complications are low and the outcomes are excellent regardless of previous abdominal operation. Dedicated catheter implantation team might be the key of success.