Sarah Markham, Wayne S Lee, MD, Tony Chan, MD, Jonathan D Svahn, MD, FACS. Department of Surgery, Kaiser Permanente Oakland, California
Introduction: Laparoscopic peritoneal dialysis (PD) catheter placement has been shown to have equal or better outcomes compared to other approaches. In the US, only 7% of all patients initiating dialysis treatment started PD. Kaiser Permanente Northern California has one of the highest proportions of patients starting dialysis on PD (25%). At Kaiser Oakland during the study period, 51% of patients started PD. Our objective was to analyze the PD placement of these patients from a surgical perspective.
Methods: A retrospective review was performed on consecutive patients initiating dialysis from February 2013 to January 2014 at a single institution, with a subset analysis of those who underwent laparoscopic PD placement by two attending surgeons. Patient characteristics, operative data, and complications were analyzed.
Results: In 50 PD catheter patients, mean age was 59.2 with slight predominance of males (55.1%). Average BMI was 29.2. Twenty percent had previous surgery, and 24% had the PD catheters placed on an urgent basis. Average case length was 46.1 minutes. There were four complications (8%) due to exit site infections. This was associated with the case length (p<0.05). Case length was associated with urgent procedures, but not with history of previous surgery or body mass index. There was also a difference in operative time between attending surgeons likely due to experience.
Conclusion: Laparoscopic PD catheter insertion is a safe minimally invasive procedure with short operative time. In conjunction with experienced nephrologists and PD nursing unit, surgeons can help facilitate a high PD rate with low complications.