Temporary stoppage of peritoneal dialysis when laparoscopic procedures are performed on patients undergoing CAPD/CCPD: a change in policy.
Laparoscopic surgery has been gaining in popularity. Prior to 1995, whenever our patients had a laparoscopic procedure it was carried out with the standard precautions, and the patient stayed on peritoneal dialysis (PD). We noticed a high incidence (71.4%) of peritonitis post laparoscopic surgery. Four of the peritonitis patients had cholecystectomies and 1 had a gastrostomy for placement of a feeding tube laparoscopically. The patients' ages ranged from 31 to 74 years; 4 (80%) were females. They had been on PD for a mean of 24 months (range 6-48 months). Peritonitis was diagnosed within a mean of 22.2 hours (r: 12-36 h) post procedure. The causative organisms were Klebsiella in two cases, Staph. aureus in one, Pseudomonas in one, with no growth observed in one. Following this, we instituted a deliberate policy of temporary cessation of PD for 2 weeks post laparoscopic procedure, maintaining the patient on hemodialysis during this period. Since the adoption of this policy, we have had no peritonitis in 7 patients who have undergone laparoscopic procedures.
Goel
S
S
Division of Nephrology, University Hospital and Clinics, University of Missouri-Columbia, USA.
Ribby
K J
KJ
Kathuria
P
P
Khanna
R
R
D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D017081:Cholecystectomy, Laparoscopic; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D006435:Renal Dialysis