title: Laparoscopic Tenckhoff catheter placement in children using a securing suture in the pelvis: comparison to the open approach.
abstract: OBJECTIVE
  Secure placement of peritoneal dialysis (PD) catheters in the pelvis has been described by various techniques. We describe minimally invasive placement using an Endo Close device, securing the catheter in the pelvis, and compare this method with standard open technique in children.
  
  
  METHODS
  A retrospective institutional review was conducted for children requiring PD access from 2001 to 2007. Patients were grouped into laparoscopic with secure placement (SP) and open placement (OP) groups. Groups were cohort-matched based on age, paying particular attention to the number of catheter migrations.
  
  
  RESULTS
  Twenty-seven patients underwent 36 procedures in SP, whereas 23 patients in OP had 32 catheter-related procedures. Exit site infections were decreased in SP (0.57 vs 1.33 episodes per patient-year). There was no difference in the number of catheter migrations (3 vs 5); however, time to migration was statistically longer in the SP group (9 vs. 2.4 months, P < .05).
  
  
  CONCLUSIONS
  Laparoscopic placement of PD catheters using a securing suture in the pelvis is a more durable technique when compared to open placement. Extending the catheter migration time is important in children when PD is used as a bridge to renal transplantation.
authors.affiliation: Arkansas Children's Hospital, Little Rock, AR 72202, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Copeland
authors.forename: Richard T
authors.initials: RT
authors.lastname: Blaszak
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Tolleson
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Saad
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jackson
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Smith
authors.forename: Evan R
authors.initials: ER
authors.lastname: Kokoska
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D010388:Pelvis; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques