Page 4 - WALS Journal

WJOLS

Two Port Laparoscopic Placement of Peritoneal Dialysis Catheter: Effective Technique

an incision in the mid-clavicular line at the level of the rate was 4%. There was no peritoneal dialysis liquid
umbilicus and passed toward a point 2 cm lateral to the leakage. The two ports technique described is an easy
midline, midway between the umbilicus and the pubic and rapid procedure, with few complications and early
symphysis, to create a subcutaneous tunnel (Fig. 1). The discharge. Due to its reliability, offers good catheter
patient is then placed in the in a 30º Trendlenburg position. function outcome. 7
PD catheter is then passed into the abdominal cavity through 2. Jincheul KO et al evaluated about 38 patients. After
the supraumbilical 10 mm port after removal of the camera. follow-up of 21.5 months (range 6-34), all catheters were
The pig tail of the catheter is directed into the pouch of working properly, although tip migrations were found
Douglas in females and the rectovesical pouch in male in the iliac fossa in three patients and in the right upper
patients assisted by a Maryland forceps placed through the quadrant in one patient. A port site hernia developed in
5 mm port. The external end of the catheter is grasped and one patient and peritonitis developed in two patients.
brought out through the 5 mm port up to the inner Teflon Only one remote migration (2.6%) occurred during the
cuff, this step is done under laparoscopic guidance. The study period. Thus, our method of laparoscopic catheter
10 mm port is closed with a purse-string suture using non- insertion might be a feasible option. 8
absorbable material such as 0-0 nylon. The catheter is then 3. Arnoud Peppelenbosch et al despite the similar outcomes
secured in the proper place with a 0-0 nylon stitch. The PD of open surgical vs laparoscopic techniques from
catheter is tested on table using normal saline. 3 randomized studies, the laparoscopic insertion has the
There are other methods like Quinton percutaneous major advantage of correct catheter positioning in the
4
catheter placement, the Moncrief-Popovich catheter lower abdomen, with the possibility of adhesiolysis. The
technique and extended dialysis catheters. 5 minimal invasive percutaneous insertion bears the risk
of bowel perforation and catheter malpositioning, and
COMPLICATIONS the outcome of this technique is strongly related to the

The complications of PD catheter are divided into early experience of the surgeon. The major complications of
(within <30 days) and late (within >30 days). 6 these implantation techniques, like bleeding, dialysate
leakage and catheter malpositioning, and their
Early: Bowel perforation, bleeding, wound infection, management are discussed in our study. Late peritonitis
outflow failure, leakage and peritonitis.
remains the major drawback of PD treatment, with the
Late: Exit-site infection, tunnel infection, cuff-protrusion, need of temporary or permanent change over to the HD
catheter migration, outflow failure and dialysate leaks or treatment in 10% of the patients. Enrichment of the
hernias. physician’s interest and experience, along with a
multidisciplinary approach to outline the optimal
AIMS AND OBJECTIVES strategy of PD-catheter insertion and complication of

Two port laparoscopic placement of PD catheter is a new the treatment, may improve the patients’ survival and
and promising technique which is reliable, efficient and with decrease the morbidity. 6
less complications. 4. Stephen P Haggerty et al evaluated about 31 patients.
The mean operating time was 52 minutes. Adhesiolysis
REVIEW OF LITERATURE was required in 9 (29%) and omentectomy or

Rapid review of literature was done using the abstracts and
at times full review of the article was done.
1. Eduard García-cruz1 et al evaluated about 51 patients
for PD catheter insertion. Mean operating time was 32
minutes (range 15-55 minutes). One patient suffered an
immediate postoperative catheter obstruction that
required surgical repositioning. No other technical intra
or early postoperative complications related to technique
were reported. Mean time to discharge 1.02 ± 2.2 days.
Catheter outflow failure rate was 7.6%. Conversion to
hemodialysis due to peritonitis was 13%. Peritonitis per
patient/year was 0.27. Catheter 6 months, 1 and 2 years Fig. 1: Two ports laparoscopic catheter placement with a
survival rate was 94, 87 and 72%. Catheter migration subcutaneous tunnel
World Journal of Laparoscopic Surgery, September-December 2012;5(3):146-149 147