[The placement of Tenckhoff peritoneal dialysis catheter by laparoscopic approach--our experience].
Stelian PanteaG LuchianCorina PanteaF LazárD BordoşMarius PăpuricăCarmen Bălaşa-GuragataS NicoarăAnca Mateş
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Ambulatory peritoneal dialysis is an alternative to haemo dialysis for patients with End Stage Renal Disease (ESRD). This study evaluates our experience in laparoscopic placement of Tenckhoff Catheter (TC) for peritoneal dialysis.Between december 2000 and december 2007 in the II Surgical Clinic of Timisoara the laparoscopic implantation of the Tenckhoff catheter was performed in a lot of 56 patients with ESRD with mean age 53.04 years (limit between 17-80 years). In this lot of patients 66 laparoscopic procedures were performed--58 catheter implantation, 2 catheter changing, 2 repositioning, 2 adhesiolysis and 2 withdrawn. Mean operative time was 47.3 min. (limits 35-90 min.).Immediate functionality ratio (< 30 days) was 98.11% of cases. The immediate post-operative complications were: leakage of dialysis solution in three patients (5.35% of cases), bleeding from the incision in three patients (5.35% of cases) and one patient (1.78% of cases) with a migration of the TC, case who required replacement of the catheter performed also by laparoscopy. The late post-operative complications were: obstruction with omentum of the catheter in two patients (3.57% of cases), massive leakage in one patient (1.78% of cases), migration of the TC in one patient (1.78% of cases), tunnel infection in one patient (1.78% of cases) and peritonitis in two patients (3.57% of cases). In all these patients laparoscopy replacement of the catheter was required. The minor complications were: exit site infection in 3 patients (5.35% of cases), tunnel infection in 7 patients (12.5 % of cases), incisional hernia in one patient and pleural effusion in one patients (1.78% of cases).Laparoscopic placement of TC is a successful method compared to other procedures. The great advantage is the direct visualization and fixation of the TC in the pelvis.Cite
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The use of continuous ambulatory peritoneal dialysis (CAPD) in children has proved beneficial. However, peritonitis remains the major complication. A review of the incidence of peritonitis in 55 children (mean age 9.6 years) who underwent CAPD between 1978 and 1984 showed that there were 67 episodes of peritonitis (1 per 9.4 patient-months) in 33 of the 55. Three patients accounted for 22 of the episodes. In all cases, treatment with antibiotics, given intraperitoneally, was successful. Cephalothin was routinely given for infections due to gram-positive organisms, tobramycin for infections due to gram-negative organisms. Peritonitis recurred in seven patients, of whom five had to have their catheters replaced because of associated chronic infections of the deep peritoneal cuff, the exit site or the catheter tunnel. Although peritonitis was a common complication of CAPD in this population, it did not affect the success of the technique.
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Objective: Catheter-related infections represent a primary infectious complication in patients with continuous ambulatory peritoneal dialysis (CAPD). A one-stage operation or two-stage procedure can be taken to remove and replace the infected catheter in CAPD patients. We retrospectively compared clinical features and outcomes between two surgical groups between 1994 and 2003 at National Cheng Kung University Hospital. Methods: We performed the two-stage procedure to replace infected catheter before 1997. In 1997, we began to adopt a one-stage surgical procedure to treat CAPD patients who had exit-site (ES) or tunnel (T) infections, but the conventional two- stage operation was performed for patients with peritonitis. During this study period from 1994 to 2003, 10 patients received the one-stage operation (eight with ES infection and two with T infection) while the other 10 patients (five with ES/T infections and five with peritonitis) received the two-stage procedure. After insertion of new catheters, the patients underwent substitutive hemodialysis therapy for 10 days prior to restarting CAPD and were subsequently followed up for at least three months. Results: The patients receiving the one-stage operation showed no significant differences in the mean age, duration of antibiotic therapy prior to operation, and clinical outcome as compared with those receiving the two-stage procedure. The interval for substitutive hemodialysis therapy prior to restarting CAPD was 10.0±0.0 days for patients in the one-stage group. In the two-stage group, the mean durations of substitutive hemodialysis therapy were 31.2±8.4 days (P=0.001) for patients with ES/T infections and 56.2±12.3 days (P=0.001) for those with peritonitis, which were longer as compared with that in the one-stage group. Conclusion: The one-stage operation seemed to yield satisfactory results in treatment of CAPD patients with ES/T infections, and shortened the interval for substitutive hemodialysis, thus allowing an early return to CAPD as compared with the conventional two-stage surgery. It is more practical and may also be safe to use the one-stage operation to treat tract-infected catheter in CAPD patients.
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The management of catheter-related infections has become a major challenge in continuous ambulatory peritoneal dialysis treatment. We identified five patients on continuous ambulatory peritoneal dialysis who failed conservative medical management for exit site infections. Each patient underwent incision and debridement along the subcutaneous course of the catheter, exteriorization of the superficial cuff, and establishment of a new exit site at the medial aspect of the wound. This novel technique of incision and debridement along the subcutaneous tunnel and relocation of the exit site has not been described in the literature. In four of five patients, this technique controlled the exit site infection and arrested the progression of the infection to peritonitis, preventing the need for catheter removal.
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To describe our experience with chronic ambulatory peritoneal dialysis in children with the prune belly syndrome (PBS).From our peritoneal dialysis (PD) program we were able to review the medical records of 6 boys with PBS. Data were collected on potential complications such as infections, hernias, growth, and problems encountered with PD catheter insertion.The ages of the 6 boys ranged from 10 months-17 years. The dialysis duration was from 9-22 months, with a total of 76 patient-months on PD. There was one death, possibly as a complication of an exit-site infection. Five received a renal transplant, and 4 have functioning grafts. Peritonitis occurred once in every 10.8 patient-months, and exit-site or tunnel infection was diagnosed every 7.6 patient-months. Four patients required PD catheter replacement because of tunnel infection in 2, persistent exit-site infection in 1, and fluid leakage in 1. Of a total of nine catheters, three were inserted using a laparoscopic technique. There were no leaks in these three; however, there was one exit-site infection. Two patients had inguinal hernias that required surgery.Deficiency of abdominal musculature in PBS poses potential problems for the use of PD, in particular, catheter anchorage, exit-site healing, and leakage. In our patients the most serious complications were infections of the exit site or catheter tunnel. Our experience suggests that a laparoscopic technique may provide improved catheter placement. PD offers a potentially successful form of dialysis for patients with PBS.
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Abstract Since January 1979, 122 patients (mean age 38.5 years, range 5–72 years) with chronic renal failure have been treated with continuous ambulatory peritoneal dialysis (CAPD). Peritoneal access was achieved by inserting silicone rubber Tenckhoff peritoneal dialysis catheters (Quinton, Seattle, Washington) by an open (76 per cent) or closed technique. Actuarial analysis showed a patient survival of 98 and 94 per cent and a success rate of 88 and 64 per cent at 1 and 2 years, respectively. Currently, 74 patients are using CAPD and 8 have been treated for 30–36 months. Thirty-five patients (29 per cent) required two or more peritoneal catheters and 69 per cent of these patients are still on CAPD. Catheter-related peritonitis was the most frequent complication (233 separate episodes in 94 patients) and necessitated catheter removal in 16 per cent of episodes, although 37 per cent of patients from whom catheters were removed because of peritonitis later resumed CAPD. Extravasation of dialysate from the peritoneal cavity (31 episodes) and catheter obstruction (31 episodes) required surgical replacement of catheters in 8 and 23 cases, respectively. Twenty patients (16 per cent) developed 24 abdominal hernias, only one of which caused failure of CAPD. Infective and mechanical complications of CAPD frequently require surgical intervention but only occasionally result in failure of the technique, and even multiple catheter replacements are compatible with successful long term CAPD.
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Background This study was to compare the postoperative complication rates of continuous ambulatory peritoneal dialysis (CAPD) catheter insertion via open technique between two groups of patients, those with and those without a history of previous abdominal surgery. Methods A review was carried out in 122 patients over a 2-year period. The patients were divided into two groups: those with and those without previous lower abdominal surgery. All patient records were retrospectively analyzed until the time of catheter failure or to current time if alive and receiving CAPD. Patient characteristics, operative factors, and postoperative complications were recorded. Results Postoperative complications were reported as catheter malfunction in 16 patients and CAPD-related peritonitis in 36 patients. The complication rates in the group of patients with previous abdominal surgery were 16.7% catheter malfunction and 33.3% CAPD-related peritonitis. In patients without previous lower abdominal surgery, a catheter malfunction rate of 12.5% and a peritonitis rate of 28.8% were seen. The operation time in patients with previous abdominal surgery was longer than that in patients without previous abdominal surgery. However, no statistically significant difference in postoperative complication rates was detected between patients with and patients without previous lower abdominal surgery. Conclusion CAPD remains a reliable modality in the treatment of end-stage renal disease and does not increase postoperative complications in patients with previous abdominal surgery.
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