Role of laparoscopy in the management of malfunctioning peritoneal dialysis catheters

ABSTRACT

To document the results of laparoscopic management of peritoneal catheter dysfunction. Descriptive case series. Department of Surgery King Fahad Medical City Riyadh KSA, from January 2009 to October 2011. A retrospective review of the records of all the patients who underwent laparoscopy for evaluation and management of peritoneal dialysis [PD] catheter dysfunction was performed. Three trocars [one 10mm and two 5 mm] were used. Recorded data included patient demographics, catheter implantation method, and date of malfunction, cause of dysfunction, procedure performed and complications. A total of 16 patients underwent laparoscopic evaluation and management for PD catheter dysfunction The primary etiology of dysfunction was omentum and / or small bowel wrapping around the catheter with adhesions [n=8], malposition of cathter [n=5] and infection [n=2]. Adhesiolysis was performed in eight cases with partial omentectomy. In five cases with malposition of catheter but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters were withdrawn because of infection [peritonitis]. In one case with tunnel infection the catheters were exchanged simultaneously making another tunnel. Laparoscopy is highly effective and successful method for evaluation and management of peritoneal dialysis catheter dysfunction.