title: Dual-incision laparoscopic surgery for peritoneal dialysis catheter implantation and fixation: a novel, simple, and safe procedure.
abstract: BACKGROUND
  Peritoneal dialysis (PD) is an alternative modality to hemodialysis and is usually used to treat patients with end-stage renal disease. Dual-incision laparoscopic surgery (DILS) had been reported in several surgical fields; however, no report was proposed about DILS in PD catheter implantation (DILS-PD). In this study, we present DILS with a novel, simple, and safe procedure for PD catheter implantation with fixation and describe the long-term outcome.
  
  
  METHODS
  We conducted a prospective data collection and retrospective review of all PD patients from April 2010 until June 2012. During this study period, we performed open surgery for PD catheter implantation (OS-PD) and DILS-PD concurrently. Demographic data, medical, operative, and postoperative findings, and information regarding complications were compared between these two groups.
  
  
  RESULTS
  Forty-eight patients had DILS-PD, and 70 patients had OS-PD. There was no difference between the two groups in age, gender, American Society of Anesthesiologists grade, creatinine level, body mass index, and previous abdominal surgery. There was no surgical mortality in either group. The follow-up period ranged from 6 to 24 months, with a mean of 22.4±16.5 months. There was no tube migration in the DILS-PD group, but 25.7% of the patients in the OS-PD group had tube migration (P<.001). A significantly decreased exit-site/tunnel infection rate was found in the DILS-PD group (4.2%) compared with the OS-PD group (17.1%) (P=.032). However, there was no obvious difference in peritonitis occurrence between groups. A significantly decreased catheter failure rate was found in the DILS-PD group (4.2%) compared with the OS-PD group (22.9%) (P=.006). DILS-PD group patients had a favorable survival rate for catheter implantation compared with OS-PD group patients.
  
  
  CONCLUSIONS
  Our DILS-PD with fixation technique is a simple and safe procedure. This procedure minimized or even eliminated the possibility of migration without additional cost. Our DILS-PD fixatation technique should be recommended for use routinely.
authors.affiliation: Department of Surgery, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chun-Nan
authors.initials: CN
authors.lastname: Yeh
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.forename: Yu-Yin
authors.initials: YY
authors.lastname: Liu
authors.forename: Chi-Tung
authors.initials: CT
authors.lastname: Cheng
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wang
authors.forename: Kun-Chun
authors.initials: KC
authors.lastname: Chiang
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.forename: Chien-Chih
authors.initials: CC
authors.lastname: Chiu
authors.forename: Shu-Man
authors.initials: SM
authors.lastname: Weng
authors.forename: Tsann-Long
authors.initials: TL
authors.lastname: Hwang
mesh_terms: D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies