Surgical management of peritoneal dialysis peritonitis: the impact of peritoneal sclerosis.
BACKGROUND
Peritonitis is a life-threatening complication of peritoneal dialysis. Peritoneal sclerosis is associated with long-term peritoneal dialysis. The aim of this study was to assess the effect of peritoneal sclerosis on outcomes following laparotomy for peritoneal dialysis peritonitis.


METHODS
A series of 63 consecutive patients underwent laparotomy for peritoneal dialysis peritonitis. Patients were divided into two groups, those with and those without simple peritoneal sclerosis identified at laparotomy. Medical, anaesthetic, and surgical notes were used for data collection. Patients with known encapsulating peritoneal sclerosis were excluded from the study.


RESULTS
Patients with simple peritoneal sclerosis had a statistically significant longer duration of peritoneal dialysis. They also had a significantly higher risk of major complications postoperatively and a greater relative risk for mortality.


CONCLUSIONS
There is an increased prevalence of simple peritoneal sclerosis with long-term peritoneal dialysis. Patients with simple peritoneal sclerosis have higher incidence of postlaparotomy complications. Patients on long-term peritoneal dialysis should be treated aggressively for peritoneal dialysis peritonitis to reduce complication/mortality rates. Evidence of simple peritoneal sclerosis at laparotomy should preclude further peritoneal dialysis.
Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Leicester, UK. pjy4@le.ac.uk
Phillip J
PJ
Yates
Jessica P A
JP
Kitchen
Monica
M
Kaushik
Michael L
ML
Nicholson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000628:therapy; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012598:Sclerosis; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome