Monika A Krezalek, MD1, Nicolas Bonamici, BS2, Brittany Lapin2, Michael Ujiki, MD2, Stephen P Haggerty, MD2. 1The University of Chicago, 2NorthShore University HealthSystem
Background: Obesity is considered a relative contraindication to peritoneal dialysis (PD). Available studies conflict regarding PD failure in the obese. Success of PD depends on the durability of the PD catheter, which is contingent on the insertion technique. Advanced laparoscopy (AL) has been shown by us (1) and others to impart lower rates of mechanical catheter dysfunction and improved catheter survival when compared to open and basic laparoscopy (BL). Whether PD catheter survival is affected by weight remains unaddressed.
Methods: We retrospectively reviewed data on 235 PD catheter insertions between 2/11/2004 and 11/26/2014. Three cohorts were created based on the catheter placement technique: open, BL using selective adhesiolysis, and AL using rectus sheath tunnel, selective omentopexy and adhesiolysis. Primary outcomes included catheter dysfunction and catheter dysfunction-free survival for each cohort by BMI: normal weight (18.5-25), overweight (25-30), obese (≥30). Nominal variables were compared using chi-square test, continuous variables using Student’s t-test, dysfunction-free survival was assessed with Kaplan-Meier method with log-rank test. Significance was established at 0.05.
Results: The demographics and preoperative BMI were not significantly different between operative groups. Across all operative techniques, similar dysfunction-free catheter survival was noted for each BMI category (log-rank p=0.39). In the AL cohort, use of omentopexy was significantly higher in obese patients compared to normal-weight and overweight individuals (p=0.002). In AL cohort, there was no difference in catheter dysfunction, perioperative complications, or early peritonitis based on BMI. At 2 years in obese patients, dysfunction-free catheter survival was 76.7% in AL, 22.7% in BL, and 44.4% in open (log-rank p<0.001) (Table1).
Conclusions: Obesity does not increase complications or shorten catheter survival regardless of the operative technique. AL techniques with omentopexy offer lower dysfunction rates and longer catheter survival compared to BL and open insertions and may be especially important in obese patients.
Table1. 2-Year Dysfunction-Free Catheter Survival
| BMI | AL | BL | Open | P-Value |
| Total | 64.5% | 35.4% | 46.9% | <0.001 |
| 18.5-25 | 54.6% | 26.7% | 46.0% | 0.17 |
| 25-30 | 61.5% | 51.0% | 50.0% | 0.33 |
| ≥30 | 76.7% | 22.7% | 44.4% | <0.001 |
| P-Value | 0.17 | 0.39 | 0.86 |
1. Krezalek MA, et al. Laparoscopic peritoneal dialysis catheter insertion using rectus sheath tunnel and selective omentopexy significantly reduces catheter dysfunction and increases peritoneal dialysis longevity. Surgery. 2016 Oct;160(4):924–35.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80245
Program Number: S153
Presentation Session: Minimally Invasive Surgery – World Tour
Presentation Type: Podium