title: Effects of a Novel Peritoneal Dialysis: The Open Versus Laparoscopic Preperitoneal Tunneling Technique.
abstract: The key to achieving adequate continuous ambulatory peritoneal dialysis (CAPD) is that a functioning catheter should enable unrestricted inflow and outflow of the dialysate liquid from the peritoneal cavity with an intact peritoneal membrane. Despite its advantages, complications, such as outflow obstruction, catheter-related infection, and dialysate leakage are still problematic. Various laparoscopic techniques for catheter placement have been investigated. The main purpose of this study was to compare the laparoscopic and open surgical peritoneal dialysis (PD) catheter insertion techniques in a retrospective manner according to catheter survival, complications and the safety of both techniques. The study included end stage renal disease patients in our hospital in whom a PD catheter was placed between 2007 and 2014. Patients were divided into two groups: the open technique (OT) group and the laparoscopic preperitoneal tunneling approach (LA) group. Extracted data included patient demographics, operative data, catheter-related complications and follow-up data. Sixty-nine patients were enrolled into the study. CAPD catheters were placed into 35 patients via LA and 34 via OT. We found that the LA group patients had better survival rates compared with the OT group, especially the long-term survivals. All of the CAPD-related complications, (peritonitis, malposition, outflow obstruction, leakage) were lower in the LA group. However, the peritonitis, malposition and groin hernia rates were also statistically significantly lower in the LA group. When compared with the published data, we recommend laparoscopic CAPD catheter placement with a preperitoneal tunneling technique. The technique is safe and offers a better outcome.
authors.affiliation: Baskent University, Department of General Surgery, Istanbul, Turkey.
authors.forename: Huseyin Yuce
authors.initials: HY
authors.lastname: Bircan
authors.affiliation: Baskent University, Department of Nephrology, Istanbul, Turkey.
authors.forename: Eyyup
authors.initials: E
authors.lastname: Kulah
mesh_terms: D000368:Aged; D061807:Catheter Obstruction / Q000706:statistics & numerical data; D055499:Catheter-Related Infections / Q000453:epidemiology; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D000069451:Long Term Adverse Effects / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate; D014421:Turkey / Q000453:epidemiology
keywords: Laparoscopic technique; Peritoneal dialysis; Preperitoneal tunneling