Minimally invasive surgery for salvage of malfunctioning peritoneal dialysis catheters

Abstract

Background: Malfunction of continuous ambulatory peritoneal dialysis (CAPD) catheters is a frequent complication and has traditionally been treated with a laparotomy. We present our experience with minimally invasive surgical (laparoscopic and thoracoscopic) salvage of CAPD catheters.

Materials and methods: Between October 2003 and June 2013, 19 patients (13 males and 6 females with a mean age of 37 years [range 28-64]) underwent minimally invasive laparoscopic salvage of malfunctioning CAPD catheters. These catheters had been placed with either a percutaneous or open technique and had been in place for a mean of 4.5 months (range 2-18 months). All the salvage procedures were performed under general anaesthesia using one 10 mm and two or three 5 mm ports. The various manoeuvres undertaken to re-establish catheter function included correct positioning the catheter and anchoring it to the pelvic peritoneum, clearing the fibrin clot/sheath, freeing up the omentum/bowel/taenia coli. In addition, all patients underwent an omentopexy.

Results: Laparoscopic salvage could be completed in 18 patients with good catheter inflow and outflow established at the end of the surgery and one patient underwent thoracoscopic salvage. The median operative time was 63 min (range 45-96 min) and median post-operative hospital stay was 2 days (range 2-5 days). Low volume dialysis was commenced the day after surgery and full volume dialysis by the 10^th day. There were no intra- or post-operative complications. All the catheters were functioning at the end of 6-month follow-up.

Conclusions: Minimally invasive surgery is a valid, safe and efficacious way of salvaging malfunctioning CAPD catheters. This modality reduces the chances of re-formation of adhesions, ensures rapid recovery, reduced wound-related complications and allows for early institution of peritoneal dialysis.

Keywords: Continuous ambulatory peritoneal dialysis; continuous ambulatory peritoneal dialysis catheter; laparoscopy; peritoneal dialysis; salvage.

Figure 1

Computed tomography scan shows the presence of contrast injected through the peritoneal dialysis catheter in the right pleural cavity

Figure 2

(a) Continuous ambulatory peritoneal dialysis catheter being freed up from encompassing fibrin sheath. (b) Fibrin sheath being excised. (c) Catheter freed from dense bowel adhesions. (d) Catheter fixed in the pelvis

Figure 3

(a) Omentum picked up with a running suture. (b) Fixation of the omentum in the left upper quadrant

Figure 4

Thoracoscopic view of sutured small pleuroperitoneal communications