title: Effective use of laparoscopy for long-term peritoneal dialysis access.
abstract: BACKGROUND
  Laparoscopy is an underused modality for peritoneal dialysis access procedures. The strengths of laparoscopy are that it can both prevent and resolve the common mechanical problems that adversely effect dialysis catheter outcomes.
  
  
  METHODS
  Laparoscopically enabled catheter implantation and rescue procedures included rectus sheath catheter tunneling, omentopexy, adhesiolysis, resection of epiploic appendices, colopexy, salpingectomy, and appendectomy. Using these techniques, the outcomes of 428 laparoscopically implanted catheters were studied.
  
  
  RESULTS
  During a mean follow-up of 21.6 months, mechanical obstruction complicated 3.7% of implantation procedures. The incidence of pericatheter leak was 2.6%. There were no occurrences of pericatheter hernia or subcutaneous cuff extrusion. Laparoscopic salvage procedures limited losses from mechanical catheter problems to .9%. Cumulative revision-free and assisted catheter survival probabilities for loss from mechanical complications at 5 years were .96 and .99, respectively.
  
  
  CONCLUSIONS
  Because it is enabled by techniques not available to other catheter-placement methods, laparoscopy produces superior outcomes.
authors.affiliation: Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente, Bellflower Medical Center, Bellflower, CA, USA. john.h.crabtree@kp.org
authors.forename: John H
authors.initials: JH
authors.lastname: Crabtree
authors.forename: Raoul J
authors.initials: RJ
authors.lastname: Burchette
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome