Laparoscopic peritoneal dialysis catheter placement in the hostile abdomen is safe and feasible with modern surgical techniques.

Peter W Lundberg, MD, Adam T Hauch, MD, MBA, Anil S Paramesh, MD, FACS. Tulane University School of Medicine

Background: Continuous Ambulatory Peritoneal Dialysis (PD) has become an increasingly popular modality of renal replacement therapy. Laparoscopic placement of peritoneal dialysis catheters may help overcome previous barriers to PD, such as previous abdominal surgeries or presence of hernias, without incurring substantially greater risks.

Methods: We performed a retrospective review of 120 consecutive patients who underwent attempted laparoscopic PD catheter placement from 07/2009-06/2014 by a single surgeon. Patient and catheter characteristics and outcomes were compared between those with and without complications as well as those with a previous history of major abdominal surgery or not.

Results: Laparoscopic PD catheter placement was aborted in 4 patients due to inability to safely dissect sufficient access to the abdominal cavity; these subjects were excluded from subsequent analysis. Mean follow up was 18.8 (± 12.9) months. Fifty-five patients had a history of major abdominal surgery compared to 61 without. No significant difference was observed with respect to age, race, sex or BMI between groups. Notably, more adjunctive procedures were required in those with previous abdominal surgery, including adhesiolysis (60.0% vs. 4.9%, p<0.0001), and hernia repair (12.7% vs. 1.6%, p=0.026). Postoperative catheter complications were not significantly different between those with or without a history of abdominal surgery (29.1% vs. 32.8%, p=0.667). Both unassisted (56.8% vs. 65.0%, p=0.397) and overall (72.7% vs. 76.7%, p=0.647) one-year catheter survival were similar between patients with or without previous surgery, and improved to 83.9% overall one-year survival upon exclusion of patients who stopped PD for non-surgical reasons.

Conclusions: Laparoscopic PD catheter placement offers a chance to establish PD access in patients traditionally viewed as non-candidates for this modality. Despite the potential risks incurred due to additional procedures at the time of catheter placement in these complicated patients, they can achieve good long-term PD access with an aggressive surgical approach.

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