The placement of peritoneal dialysis catheters: a prospective randomized comparison of open surgery versus "Mini-Perc" technique

Abstract

Purpose: Currently, most ESRD patients are treated with open surgical technique or with laparoscopic technique. In this study, we examined the role of the ureteroscope-assisted "Mini-Perc" technique versus the modified open surgery in the treatment of ESRD in a prospective randomized manner.

Methods: A total of 72 patients with chronic renal failure were prospectively randomized for the ureteroscope-assisted "Mini-Perc" technique or modified open surgery. Intraoperative and postoperative morbidity, incision size, dose of local anesthesia, operative time, hospital stay, and initial catheter survival and follow-up were compared for both methods.

Results: "Mini-Perc" group was associated with shorter incision size, operative time, and hospital stay, with lower dose of local anesthesia and incidence of bloody ascites. Two of five patients with the history of abdominal surgery in "Mini-Perc" group required adhesiolysis under direct vision of telescope. All adhesions were easily dissected. All complications of leakage (8.1 %) and incisional hernia (2.7 %) occurred in the open surgery group, but a difference of no significant value with "Mini-Perc" group (p = 0.2400, p = 1.0000). There was no any other significant difference in common complications between two groups. After 2 years of follow-up, 54 patients (75 %) survived with their initial PD catheter. The overall death was 5 (6.9 %).

Conclusions: Compared to modified open surgical technique, the ureteroscope-assisted "Mini-Perc" technique can be used to achieve the same clinical efficacy for placement of peritoneal dialysis catheters in ESRD patients, and it carries minimal morbidity.