A new laparoscopic technique for the placement of a permanent peritoneal dialysis catheter: the preperitoneal tunneling method.
BACKGROUND
Mechanical outflow obstruction and leakage from the exit site of the catheter are two common complications of continuous ambulatory peritoneal dialysis. To lessen these complications and to achieve immediate use of the catheter, we developed a new laparoscopic technique for catheter placement.


METHODS
A total of 12 consecutive patients with end-stage renal failure were included in this study between April 2003 and July 2003. The average age of the patients was 42.4 years (range, 37-72). Patients were excluded only if a serious risk for general anesthesia was found. Using two 5-mm ports and a 3.3-mm mini-laparoscope, a peritoneal dialysis catheter was passed through a preperitoneal tunnel before the tip of the catheter was introduced into the pelvis. Routine peritoneal dialysis was started immediately after the operation while the patients were still in the operating room.


RESULTS
The mean operating time was 18.6 min (range, 12-37). There was no operative morbidity. The mean follow-up period was 4.3 months (range, 3-7). No leakage of the dialysate liquid or outflow obstruction was observed during this period.


CONCLUSIONS
The advantages of this method include accurate placement, preperitoneal fixation, and immediate use of the catheter for routine peritoneal dialysis. We also believe that because of the preperitoneal fixation of the catheter, this technique will decrease outflow obstruction, which usually occurs due to omental wrapping or displacement of the catheter tip.
Comert
M
M
Department of surgery, School of Medicine, Z.K.U. Arastrima Ve Uygulama Hastanesi Bashekimligi, 67700 Zonguldak, Kozlu, Turkey. mustafacomert@hotmail.com
Borazan
A
A
Kulah
E
E
Uçan
B Hamdi
BH
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011028:Pneumoperitoneum, Artificial