Radiological versus laparoscopic insertion of peritoneal dialysis catheter: a study comparing outcomes at a single centre.

BACKGROUND: Although peritoneal dialysis (PD) is a well-established and effective form of renal replacement therapy in end-stage renal failure (ESRF) patients, there is no consensus as to the optimal insertion technique. This study compares the outcomes of PD catheters inserted radiologically versus laparoscopically at a single centre. METHODS: Patients who underwent either radiological PD catheter insertion (RC) or laparoscopic insertion (LC) between 2013 and 2019 were retrospectively reviewed. Primary outcome was catheter patency at 12 months. Secondary outcomes included exit-site infections, peritonitis, and pericatheter leaks within 30 days of insertion, any complications associated with insertion, overall catheter survival, and inpatient length of stay (LoS). RESULTS: There were 81 patients included in this study, with a total of 100 procedures performed (RC = 48, LC = 52). There were significantly fewer overall complications in the LC group compared to the RC group (P < 0.001). However, when individual complications were considered, this significant difference was only seen in the rate of malpositioned catheters (10.4% versus 0%, P = 0.023). Hospital LoS was longer in the LC group compared to the RC group (3 versus 2 days, P = 0.004), but this was outweighed by the fact that there were more laparoscopically inserted PD catheters still functioning and patent at 12 months compared to those inserted radiologically. CONCLUSION: This study has demonstrated that our laparoscopic PD catheter insertion technique of securing the catheter tip low in the pelvis is safe and effective, providing a lower complication rate and longer-term viability when compared to the radiological percutaneous approach.

Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines.

BACKGROUND: The 2009 American Thyroid Association (ATA) three-tiered risk stratification, and its updated version in 2015, provided clearer guidance on the use of radioactive iodine (RAI) ablation in differentiated thyroid cancer (DTC) patients. This study examines the impact of these guidelines on RAI use in our institution. METHODS: Patients diagnosed with DTC during three different time periods (group 1: 2002-2006, group 2: 2010-2014 and group 3: 2017-2018) were identified and risk stratified according to the ATA guidelines. RAI use and extent of surgery were compared between the three groups. Categorical variables were analysed using Fisher's exact (2 × 2) and chi-squared (>2 × 2) tests. RESULTS: A total of 415 patients were included (group 1 = 88, group 2 = 215, group 3 = 112). The proportion of patients having total thyroidectomy were 84.6, 84.7 and 69.6% in groups 1, 2 and 3, respectively (P = 0.003). Central lymph node dissection was significantly higher in the more contemporary groups compared to group 1 (9.1 versus 41.9 versus 64.3%, P < 0.001). Overall, fewer patients received RAI in more recent times (76.6 versus 54.8 versus 26.8%, P < 0.001), most evident in the low-risk patients (70 versus 29.1 versus 5.1%, P < 0.001). In the high risk group, the majority received RAI, with no difference between the groups. CONCLUSION: Comparing DTC patients treated in our unit before and after publications of the 2009 and 2015 ATA guidelines, more nodal surgery was performed with less RAI administered in the latter groups. Better risk stratification according to the ATA guidelines has allowed more judicious use of RAI ablation.