Surgical aspects and complications of continuous intraperitoneal insulin infusion with an implantable pump.
OBJECTIVE
Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump is safe and effective in selected subjects with diabetes. Our aim was to assess surgical experience and complications with CIPII.


METHODS
We performed a retrospective longitudinal observational cohort study of patients that started with CIPII from 1990 to 2006. Operation free period and complication rate were compared between patients initiating CIPII before 2000 and from 2000 onwards.


RESULTS
In 63 patients, 166 re-operations were performed during 381 patient-years. Re-operations were pump replacement due to end-of-battery life (47%), laparoscopic catheter-related procedures (29%) and other interventions (24%). Median operation free period increased from 21 to 78 months from 2000 onwards (p = 0.039). Nineteen percent of patients developed complications. No operation-related mortality was reported.


CONCLUSIONS
Increased experience together with technical improvements has led to an increase of the operation free period. The absence of procedure-related mortality and a low complication rate makes CIPII feasible for selected patients with diabetes.
Haveman
Jan Willem
JW
Department of Surgery, Isala Clinics, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands. janwillemhaveman@gmail.com
Logtenberg
Susan J J
SJ
Kleefstra
Nanne
N
Groenier
Klaas H
KH
Bilo
Henk J G
HJ
Blomme
Adri M
AM
D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D004867:Equipment Design; D004868:Equipment Failure; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007263:Infusions, Parenteral / Q000295:instrumentation; D007328:Insulin / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011336:Probability; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D007328:Insulin