Laparoscopic revision of peritoneal dialysis catheters with outflow obstruction

Abstract

Purpose: Mechanical outflow obstruction is one of the most important complications encountered by chronic peritoneal dialysis patients. Our aim was to assess the effectiveness of partial omental resection and suturing the dialysis catheter on the pelvic peritoneum via laparoscopic revision in the patients who developed mechanical outflow obstruction.

Patients and Methods: 26 peritoneal dialysis patients with mechanical outflow obstruction underwent laparoscopic catheter revision between March 2007 and January 2009. Revision technique, duration of operation, hospital stay, complications were evaluated, catheter and patient survival analyzed.

Results: Mean duration of the operation was 75+13 minutes. 65,3% of the obstruction was caused by omental wrapping. Mean hospital stay was 2,2 +0,4 days. Patients started peritoneal dialysis 27,8 +6,2 hours after the procedure. Early postoperative complications were dialysate leakage (n=2), and peritonitis (n=1). İntraoperative bleeding developed in 2 patients during partial omentectomy and hemostasis was maintained laparoscopically. Mean catheter survival was 9,7±1,6 (range 4-14) months. 4 patients who developed obstruction underwent relaparoscopy for catheter revision. 9 patients underwent renal transplantation, 4 patients switched to hemodialysis because of recurrent obstruction and frequent peritonitis. 13 patients still continue to apply peritoneal dialysis. Catheter salvage rate by laparoscopic revision was 84,7 %.

Conclusion: Laparoscopic revision is safe and easy for the mechanical outflow obstruction of peritoneal dialysis catheters. Suture fixation of the catheter on to the anterior pelvic peritoneum and partial omental resection may maintain effective dialysis and prolong catheter survival by preventing catheter migration.