title: Laparoscopic techniques enable peritoneal dialysis in the difficult abdomen.
abstract: OBJECTIVE
  Continuous ambulatory peritoneal dialysis has become an increasingly popular modality of renal replacement therapy. Laparoscopic placement of peritoneal dialysis catheters may help overcome previous barriers to peritoneal dialysis, such as previous abdominal surgical procedures or the presence of hernias, without incurring substantially greater risks.
  
  
  METHODS
  We performed a retrospective review of 120 consecutive patients who underwent attempted laparoscopic peritoneal dialysis catheter placement between July 2009 and June 2014 by a single surgeon. Patient and catheter characteristics and outcomes were compared between patients with and without complications, as well as between patients with a history of major abdominal surgery and those without such a history.
  
  
  RESULTS
  Laparoscopic peritoneal dialysis catheter placement was aborted in 4 patients because of an inability to safely achieve sufficient access to the abdominal cavity through dissection; these patients were excluded from subsequent analysis. The mean follow-up period was 18.8 ± 12.9 months. Fifty-five patients had a history of major abdominal surgery compared with 61 without such a history. No significant difference was observed with respect to age, race, sex, or body mass index between groups. Notably, more adjunctive procedures were required in patients with previous abdominal surgery, including adhesiolysis (60.0% vs 4.9%, P < .0001) and hernia repair (12.7% vs 1.6%, P = .026). Postoperative catheter complications were not significantly different between patients with and patients without a history of abdominal surgery (29.1% vs 32.8%, P = .667). Both unassisted (56.8% vs 65.0%, P = .397) and overall (72.7% vs 76.7%, P = .647) 1-year catheter survival rates were similar between patients with and patients without previous surgery, and the overall 1-year survival rate improved to 83.9% on exclusion of patients who stopped peritoneal dialysis for nonsurgical reasons.
  
  
  CONCLUSIONS
  Laparoscopic peritoneal dialysis catheter placement offers a chance to establish peritoneal dialysis access in patients traditionally viewed as noncandidates for this modality. Despite the potential risks incurred because of additional procedures at the time of catheter placement in these complicated cases, these patients can achieve good long-term peritoneal dialysis access with an aggressive surgical approach.
authors.affiliation: Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Hauch
authors.affiliation: Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Lundberg
authors.affiliation: Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Anil S
authors.initials: AS
authors.lastname: Paramesh
mesh_terms: D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation*; D010537:Peritoneum / Q000601:surgery; D012189:Retrospective Studies
keywords: Abdominal surgery; Catheter; Continuous ambulatory peritoneal dialysis; Laparoscopy