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A new simplified one port laparoscopic technique of peritoneal dialysis catheter placement with intra-abdominal fixation

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Abstract

Background

Various laparoscopic techniques have been described for the insertion of peritoneal dialysis catheters. However, most use 3 to 4 ports, thus multiplying the potential risk for abdominal wall complications (hemorrhage, hernia, leaking).

Methods

A Tenckhoff catheter was placed laparoscopically, using just 1 port, in 13 consecutive patients with end-stage renal failure. All catheters were fixed in the abdominal cavity with no additional ports for this purpose.

Results

After a follow-up of 76 patient-months, all catheters are working properly. There were no postoperative wall hemorrhages, early leaking, or hernias. There was 1 case of catheter migration and 2 cases of late leaking in 2 patients in total, due to severe constipation. There were no exit site or tunnel infections. One episode of peritonitis was successfully treated with antibiotics.

Conclusion

The simplicity and the rapidity of the method justifies serious consideration for its use as the standard Tenckhoff catheter placement.

Section snippets

Methods

Through a supra-umbilical 1-cm incision, a 10-mm port is placed using the open laparoscopic technique [20]. This port serves for the pneumoperitoneum installation and the introduction of the optics. The Peritoneal Catheter kit (Quinton Instrument Company, Seattle, WA) for modified Seldinger (Littleford-Spector) technique and a 16 French Pull-Apart Sheath Introducer (Sherwood Medical Company, St. Louis, MO) are used for the catheter placement. The length of the catheter to be inserted has been

Results

From March 2004 to February 2005 we used this technique on 13 consecutive patients with end-stage renal failure. The contraindications for the technique were those regarding general anesthesia and pneumoperitoneum. Three patients had previous operations of the lower abdomen. One of these patients necessitated the use of an additional port for adhesiolysis. No case was converted to open surgery. The patients were evaluated monthly for a mean follow-up period of 5 months.

One surgeon (H.H) with an

Comments

Since the lack of controlled studies makes it impossible to answer in a definitive way which technique for peritoneal dialysis catheter placement is best, we prefer to approach the problem as a 2-fold question: what is the safest access in the peritoneal cavity for the catheter placement and which technical factors influence the longevity of a peritoneal catheter?

For the first problem, a wise solution would be a method whose access combines the pros of every method—local anesthesia (as with

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