The laparoscopic option in the management of peritoneal dialysis catheter revision.
BACKGROUND
Long-term functioning of peritoneal dialysis catheters (PDCs) depends on maintenance of pelvic positioning and prevention of the formation of adhesions. The purpose of this study was to evaluate the validity of laparoscopy as a tool for the correction of malfunctioning PDCs and to introduce our specially designed technique.


METHODS
The charts of 12 patients who underwent laparoscopic revisions of malfunctioning PDCs between May 1997 and June 2000 were reviewed for perioperative complications and long-term outcomes. We describe the causes of malfunction of PDCs and the laparoscopic technique for their revision.


RESULTS
Of the 12 patients studied, the malfunction of eight catheters resulted from migration of the catheter into the upper abdomen. In 4 patients, formation of adhesion of either small bowel or omentum resulted in the malfunction of the PDC. The only complication we encountered was bleeding. It occurred in 3 patients, 1 of whom needed reoperation in order to achieve hemostasis. Over a median follow-up of 21 months all PDCs treated this way are functioning.


CONCLUSIONS
The laparoscopic management of malfunctioning PDCs is a valid option for the treatment of such a complication.
Ovnat
A
A
Department of Surgery B, Soroka University Medical Center, Goldman Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
Dukhno
O
O
Pinsk
I
I
Peiser
J
J
Levy
I
I
D000005:Abdomen / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000473:pathology / Q000601:surgery; D006801:Humans; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009852:Omentum / Q000473:pathology / Q000601:surgery; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D010532:Peritoneal Diseases / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000601:surgery; D012086:Reoperation / Q000379:methods; D000267:Tissue Adhesions / Q000150:complications / Q000517:prevention & control / Q000601:surgery