Baris D Yildiz, MD. ANKARA NUMUNE TEACHING HOSPITAL
Introduction: Peritoneal dialysis catheter is usually the firstline treatment for patients who have kidney failure. The procedure is usually carried out by nephrologists under local anesthesia and the catheter is placed blindly into the abdomen.
Methods and Patients: Eight patients who had peritoneal dialysis catheter placement where referred for catheter dysfunction. Catheter dysfunction was first detected by the dialysis nurse and verified by the nephrologist. Then typical conservative interventions (i.e irrigation, laxatives etc) were undertaken for every patient. Every patient had an abdominal X-ray to verify the position of the catheter inside abdomen. All patients had laparoscopic revision of the catheters under general anesthesia. One ten milimeter port was inserted supra umbilically, one ten milimeter trocar was placed in right upper quadrant and one 5 millimeter trocar was placed in left lower quadrant. After freeing the catheter the tip of the catheter was taken out via the right upper quadrant trocar and thoroughly cleaned with removal of the tissue trapped within the holes of the catheter. The catheter was returned to abdomen and stitched to the peritoneum in right lower abdominal wall. Low flow irrigation was started immediately after surgery.
Results: The mean time of referral since initial catheter placement was 6.4 days. Mean surgery length was 37 minutes. All patients had infra umblical midline incision and a left lateral skin entry site performed by the nephrologist. This did not adversely effect performance of laparoscopy. In all patients the peritoneal dialysis catheter was strangled by the omentum and was pulled to right upper quadrant. None of the patients required a second surgery or replacement of the catheter after first laparoscopic intervention. There was not any complication related to surgical intervention. All patients were discharged the same day.
Conclusion: Laparoscopic revision of peritoneal dialysis catheter is an effective way of managing dysfunctioning catheters. Catheter tip should be searched in right upper quadrant and should be cleaned thoroughly. Three trocars are enough for the intervention. Stitching of the catheter to the peritoneum seems to be preventing the re-location of the catheter tip secondary to misplaced catheter body. Low flow irrigation after surgery is of paramount importance to prevent clogging of the holes on catheter.