Effective use of laparoscopy for long-term peritoneal dialysis access.
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.
Crabtree
John H
JH
Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente, Bellflower Medical Center, Bellflower, CA, USA. john.h.crabtree@kp.org
Burchette
Raoul J
RJ
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