Venkatarami Reddy Vutukuru, Associate Professor, Ram R, Professor. Sri Venkateswara Institute of Medical Sciences
Background: Peritoneal dialysis (PD) is increasingly being used as a primary mode of renal replacement therapy. Access is provided with a PD catheter. Various techniques of catheter insertion both laparoscopic and open are described in literature. Major problem is catheter dysfunction due to adhesions, catheter tip migration, omental wrapping. Advanced laparoscopic technique involves adhesiolysis, suture fixation of catheter, and Omentopexy. We present our results of CAPD catheter insertion using advanced laparoscopic technique.
Materials & Methods: All patients who underwent advanced laparoscopic PD catheter insertion and reinsertion between December 2013 to March 2018 were included. All patients underwent adhesiolysis if present, omentopexy in the left hypochondrium, catheter fixation with transabdominal suture. Post operatively followed up for complications such as bleeding, leak, catheter dysfunction, infection and the need for catheter removal. (Video of procedure will be shown).
Results: 200 cases of advanced laparoscopic CAPD catheter insertions were done. Of which, 172 were primary and 28 were reinsertions or correction of catheter dysfunction following open insertion earlier. Mean age is 53.48 years. Males constituted 72%. Average duration was 28 (21-55) min. Adhesiolysis was done in 34% of patients. 164 patients had omentopexy done. Others had parietal adhesions precluding the need for omentopexy. In 28 patients of catheter reinsertion, dysfunction was due to omental and bowel wrapping with catheter migration in 27 and 1 patient had catheter transected. Postoperatively, six patients had pericatheter leak which subsided. No infections noted. 4 (2%) patients had catheter dysfunction which required redo surgery over a period of minimum 3 months follow up. Mean hospital stay was 2 days.
Conclusion: Advanced laparoscopic PD catheter insertion or reinsertion using adhesiolysis, catheter fixation and omentopexy has the lowest reported rate of catheter dysfunction even in patients with prior abdominal surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96023
Program Number: P637
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster