Routine omentectomy is not required in children undergoing chronic peritoneal dialysis.
A routine omentectomy is recommended in children commencing chronic peritoneal dialysis, but is not routine practice in adults. We reviewed the outcome of 66 catheters (57 straight and 9 spiral) inserted into 38 patients (median age 7.8 years, 12 patients under 2 years) over a period of 4.8 years. The aim of the study was to determine whether an omentectomy affects the incidence of catheter blockage or peritonitis. Mean catheter life was 6.8 months (range 0.2-28 months). Fifteen are still in situ, and 14 were removed electively (transplantation). Blockage occurred in 1/22 catheters inserted after an omentectomy, compared with 10/44 inserted without an omentectomy (absolute risk reduction with omentectomy = 0.18). Blockage was more frequent with spiral catheters (4/9 vs 7/57; p < 0.05). Thirty-seven catheters were associated with one or more episodes of peritonitis. Peritonitis was not significantly more frequent after omentectomy. We conclude that a routine omentectomy is not routinely indicated in children commencing chronic peritoneal dialysis. Eleven omentectomies are required to prevent two omental blockages (1/0.18), and secondary omentectomy after blockage is a straightforward procedure. Spiral catheters conferred no benefit in this study. Omentectomy does not influence the incidence of peritonitis.
Lewis
M
M
Department of Paediatric Nephrology, Royal Manchester Children's Hospital, United Kingdom.
Webb
N
N
Smith
T
T
Roberts
D
D
D000293:Adolescent; D001064:Appendicitis / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D009852:Omentum / Q000601:surgery*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods; D010538:Peritonitis / Q000209:etiology