Advanced Laparoscopic Techniques Significantly Improve Function of Peritoneal Dialysis Catheters

Background: Continuous Ambulatory Peritoneal Dialysis (CAPD) catheters provide an alternative to hemodialysis in an increasing population of patients with chronic kidney disease. However, CAPD catheters have traditionally been associated with high rates of non-function using both the open and laparoscopic approaches. New advanced laparoscopic techniques utilizing rectus sheath tunneling and selective omentopexy have been reported to improve catheter function.

Methods: This study retrospectively reports the Cleveland Clinic experience during the transition from basic to advanced laparoscopic techniques between June 2002 and July 2008. A total of 201 patients were identified, of which 68 patients underwent insertion with basic techniques and 133 patients received catheters utilizing advanced techniques. Primary non-function, procedural complications, and overall non-function rates were analyzed using the most recent follow-up through June 2008.

Results: Primary catheter non-function occurred in 25 of 68 (36.7%) patients in the basic group, whereas this occurred in only 6 of 133 patients (4.5%) in the advanced group (p < 0.0001). Furthermore, 4 of these 6 pts had their catheters successfully revised with salvage laparoscopy, thereby further decreasing the rate of primary catheter losses to 1.5%. The overall rate of complications including non-function from primary and secondary sources, peritoneal leak, peritonitis, port-site hernia and bleeding occurred in 31 of 68 (45.6%) patients in the basic group and 21 of 133 (15.79%) patients in the advanced group (p < 0.0001).

Conclusion: This data clearly shows a significant improvement in CAPD catheter function utilizing selective ometopexy and rectus sheath tunneling. These advanced laparoscopic techniques should be considered the preferred method of CAPD catheter insertion.

Session: Podium Presentation

Program Number: S118

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