Pointers for Laparoscopic Peritoneal Dialysis Entry Surgical procedure

Guidelines for Laparoscopic Peritoneal Dialysis Access Surgery
January 5, 2021 0 Comments

This doc was reviewed and accredited by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in Jun 2014.

Stephen Haggerty, MD, Scott Roth, MD, Danielle Walsh, MD, Dimitrios Stefanidis, MD, PhD, Raymond Value, MD, Robert D. Fanelli, MD, Todd Penner, MD, William Richardson, MD
SAGES Pointers Committee

Corresponding Creator:

Stephen P. Haggerty, MD, FACS
Division of Normal Surgical procedure
NorthShore College Healthsystem, Evanston, IL
Scientific Assistant Professor of Surgical procedure
College of Chicago Pritzker Faculty of Medication
777 Park Avenue West, #3464
Highland Park, IL 60035
847-570-1700
[email protected]

Preamble

The usage of peritoneal dialysis (PD) as a main mode of renal alternative remedy has been growing around the globe. The surgeon’s function in caring for these sufferers is to offer entry to the peritoneal cavity by way of a PD catheter and to diagnose and deal with catheter issues. Because the early Nineteen Nineties laparoscopy has been utilized by many grownup and pediatric surgeons for insertion of PD catheters in addition to for salvage of malfunctioning catheters. This doc is an proof primarily based guideline primarily based on a assessment of present literature and the opinions of consultants within the area. It gives particular suggestions to help surgeons who care for grownup and pediatric peritoneal dialysis sufferers.

Disclaimer

Pointers for scientific observe are meant to point preferable approaches to medical issues as established by consultants within the area. These suggestions will probably be primarily based on present knowledge or a consensus of skilled opinion when little or no knowledge can be found. Pointers are relevant to all physicians who deal with the scientific drawback(s) with out regard to specialty coaching or pursuits, and are meant to point the preferable, however not essentially the one acceptable approaches as a result of complexity of the healthcare atmosphere. Pointers are meant to be versatile. Given the big selection of specifics in any well being care drawback, the surgeon should at all times select the course finest suited to the person affected person and the variables in existence in the mean time of choice.

Pointers are developed below the auspices of the Society of American Gastrointestinal and Endoscopic Surgeons and its numerous committees, and accredited by the Board of Governors. Every scientific observe guideline has been systematically researched, reviewed and revised by the rules committee, and reviewed by an applicable multidisciplinary group. The suggestions are subsequently thought-about legitimate on the time of its manufacturing primarily based on the info accessible. Every guideline is scheduled for periodic assessment to permit incorporation of pertinent new developments in medical analysis information, and observe.

Literature Evaluate

A scientific literature search was carried out on MEDLINE in Could 2010 and was up to date January 2013. Articles have been restricted to English language. Extra articles discovered on the most recent search have been included within the totals and included into the rule ultimate draft. The search technique is detailed in Desk 1. Our search technique recognized 66 articles on laparoscopic insertion of PD catheters. Of those 37 have been on salvage and 14 on peritoneoscopic insertion. The abstracts have been reviewed by two committee members (SPH, JSR) and divided into the next classes:

(a) Randomized research, meta-analyses, and systematic opinions
(b) Potential research
(c) Retrospective research
(d) Case stories
(e) Evaluate articles
(f) Scientific observe pointers

Desk 1. Search technique in Adults

  1. Exp laparoscopy / (53525)
  2. Exp peritoneal dialysis/ (19953)
  3. Exp catheters/ (14085)
  4. Exp catheterization/ (159303)
  5. 3 or 4 (167516)
  6. 2 and 5 (1642)
  7. 1 and 6 (154)
  8. Restrict 7 to (English language and people) (141)
  9. 8 and 2006:2011.(sa_year).(39)
  10. Peritoneal dialysis catheter:.mp. (560)
  11. 1 and 10 (115)
  12. Restrict 11 to (English language and people) (106)
  13. Restrict 12 to “all grownup (19 plus years)” (66)

Randomized managed trials, meta-analyses, and systematic opinions have been chosen for additional assessment together with potential and retrospective research when the next stage of proof was missing. For inclusion, potential and retrospective research needed to report outcomes on no less than 30 laparoscopic PD catheter insertions. Research with smaller samples have been thought-about when extra proof was missing. The newest opinions have been additionally included. All case stories, previous opinions, and smaller research have been excluded. Duplicate publications or affected person populations have been thought-about solely as soon as. At any time when the accessible proof from Degree I research was thought-about to be satisfactory, decrease proof stage research weren’t thought-about.

The reviewers graded the extent of proof and searched the bibliography of every article for added articles which will have been missed throughout the authentic search. Extra related articles have been obtained and included within the assessment for grading. A separate search pertaining to pediatric sufferers was undertaken in 2013. The search technique is printed in Desk 2. As a result of decrease case numbers, potential and retrospective research in pediatric sufferers needed to report outcomes on no less than 15 peritoneal dialysis catheter insertions. Research with smaller samples have been thought-about when extra proof was missing. 45 articles related to pediatric sufferers have been reviewed by a committee member (DW). General, a complete of 170 graded articles related to laparoscopic PD insertion have been included on this assessment to formulate the suggestions on this guideline.

Desk 2. Search technique in pediatrics

  1. Peritoneal Dialysis (14640)
  2. Catheters, Indwelling (16007)
  3. 1 AND 2 (788)
  4. Restrict 3 to English Language and people (712)
  5. Restrict 4 to “all youngster (0 to 18 years) (148)
  6. Restrict 5 to yr = 1985-2013

Ranges of Proof

The standard of the proof and the energy of the advice for every of the rules have been assessed in line with the GRADE system. There’s a 4-tiered system for high quality of proof (very low (+), low (++), average (+++), or excessive (++++)) and a 2-tiered system for energy of advice (weak or sturdy).

INTRODUCTION

The idea of peritoneal dialysis (PD) has been a piece in progress for over a century. The primary report of “peritoneal irrigation” as a profitable remedy of renal failure was in 1946 by Frank, Seligman and High-quality[1]. Grollman continued to advance the method utilizing a canine mannequin at College of Texas Southwestern Medical Faculty[2]. Maxwell and colleagues have been the primary to explain a method just like at this time’s type of peritoneal dialysis exchanges in a “closed system” utilizing industrial options, disposable tubing and a nylon catheter[3]. By 1980 steady ambulatory peritoneal dialysis (CAPD) had turn out to be a confirmed mode of renal alternative remedy[4, 5] and was being provided in over 116 medical facilities in america[4, 5]. Its use has steadily grown all through the world in order that the % of renal failure sufferers on PD in 1998 have been: 13% USA, 37% Canada, 42% UK, 91% Mexico, 81% Hong Kong, and 6% Japan[6]. Latest knowledge present the utilization has fallen to seven % in america[6, 7] and plenty of imagine this decline is because of an absence of accessible consultants to put and take care of the catheters[8]. In distinction to adults, 40% of sufferers ages 0-19 provoke and are maintained on peritoneal dialysis, with 96% of infants and toddlers utilizing this modality[7, 9]. Throughout the globe, PD catheters are positioned by nephrologists, surgeons and interventional radiologists primarily based on availability and particular person experience. Peritoneal dialysis catheters could also be positioned on the bedside, in a fluoroscopic suite or an working room. This guideline will talk about affected person choice and insertion choices whereas specializing in strategies of laparoscopic PD catheter insertion. It can additionally assessment analysis and administration of malfunctioning catheters, once more specializing in laparoscopic surgical strategies.

PATIENT SELECTION

Guideline advice

  1. Contraindications for laparoscopic PD catheter placement embody lively stomach an infection and uncorrectable mechanical defects of the stomach wall (+++ Proof, Robust advice)
  2. Historical past of prior stomach surgical procedure, no matter what number of, will not be a contraindication to laparoscopic PD catheter insertion. It’s applicable for surgeons with expertise in superior laparoscopy to aim lysis of adhesions and catheter placement in these sufferers. (++Proof, Robust advice)
  3. Sufferers with stomach wall hernias ought to be identified and repaired earlier than or concurrently PD catheter insertion. A restore ought to be chosen that minimizes peritoneal dissection and doesn’t place mesh intraperitoneally (++ Proof, Weak advice)
  4. Peritoneal dialysis could also be initiated in sufferers with intraabdominal overseas our bodies reminiscent of after open stomach aortic aneurysm graft restore, however a 4 month ready interval is advisable. Very restricted knowledge exists concerning peritoneal dialysis within the presence of an adjustable gastric band. (++ Proof, Weak advice)
  5. Peritoneal dialysis could also be safely initiated in sufferers with ventriculoperitoneal shunts (++ Proof, Weak advice)
  6. Gastrostomy tubes can be utilized in pediatric sufferers on peritoneal dialysis, although placement by blind percutaneous endoscopic method (PEG) seems to be related to increased an infection charges in comparison with open insertion. (++ Proof, Weak advice)
  7. Laparoscopic PD catheter insertion with carbon dioxide pneumoperitoneum requires common anesthesia. Sufferers who’re excessive threat to endure common anesthesia ought to be thought-about for a method of catheter insertion that solely requires native anesthesia and sedation, reminiscent of open insertion or fluoroscopically guided percutaneous insertion. Laparoscopic insertion utilizing nitrous oxide pneumoperitoneum and native anesthesia can be an choice the place accessible. (++ Proof, Weak advice)

Indications

Sufferers are typically referred to a surgeon from a nephrologist for catheter placement as soon as the choice is made to provoke peritoneal dialysis. The indications for renal alternative remedy are discovered within the nephrology literature and should not throughout the scope of this guideline. Using PD as a house remedy affords better affected person autonomy and high quality of life than in-center hemodialysis (HD).[10]. Not surprisingly, affected person satisfaction has been proven to be considerably increased in PD sufferers[10-12]. As well as, PD will be advantageous within the pre-transplantation interval and extend residual renal operate in comparison with HD[13]. It additionally results in a slight survival benefit throughout the first two years of renal alternative remedy and there’s an enchancment in anemia of kidney illness (considerably decrease necessities of erythropoietin)[13]. Nonetheless, there aren’t any randomized managed trials evaluating the 2 modalities. Lastly, peritoneal dialysis could also be favored in sufferers with vascular entry failure, intolerance to hemodialysis, congestive coronary heart failure, lengthy distance from dialysis middle, and peripheral vascular illness and bleeding diathesis[14]. Peritoneal dialysis may be most well-liked by sufferers with the potential for renal Transplantation within the close to future, needle anxiousness and lively life-style[14].

Absolute Contraindications

The situations under are thought-about absolute contraindications to PD catheter placement for renal alternative remedy. Novel makes use of like PD for remedy of edema within the open stomach affected person, or catheter placement for ascites administration or intraperitoneal chemotherapy should not mentioned and ought to be thought-about on a case by case foundation.

  1. Documented lack of peritoneal operate reminiscent of ultrafiltration failure of the peritoneal membrane. [14, 15].
  2. Within the absence of an appropriate assistant, impaired bodily and psychological capability of the affected person to securely use the gear each day, (extreme lively psychotic dysfunction, marked mental incapacity, poor dwelling state of affairs, impaired handbook dexterity, and blindness)[14, 15].
  3. Extreme protein malnutrition and or proteinuria > 10 g / day[14, 15].
  4. Lively intraabdominal, stomach wall or pores and skin an infection which results in excessive incidence of catheter an infection by direct contact, reminiscent of lively Crohn’s illness, ulcerative colitis and ischemic colitis. Frequent episodes of diverticulitis are additionally a contraindication since there could also be an elevated threat for transmural contamination by enteric organisms[14, 15].

Relative contraindications

There are particular situations which can be relative contraindications to PD catheter insertion or particularly laparoscopic insertion if there’s a very excessive threat of issues or failure of dialysis to work.

1. Decreased Capability Of Peritoneal Cavity

The peritoneal cavity should permit as much as two liters of fluid to dwell at any time for peritoneal dialysis to be efficient. In pediatric sufferers, an alternate quantity of 1,000 to 1,100 ml/m2 BSA is advisable, although in infants and toddlers lower than 2 years of age, this can be decreased to 800 mL/m2 BSA[16, 17]. Ladies beginning third trimester of being pregnant or sufferers with intensive stomach adhesions that aren’t amenable to surgical correction wouldn’t have applicable capability of the peritoneal cavity for dialysate[15]. Nonetheless, it’s troublesome to foretell the diploma of adhesions preoperatively. After stomach surgical procedure adhesions between the omentum and stomach wall happen in over 80% of sufferers and contain the small gut as much as 20% of the time[18]. In a pattern of 436 sufferers who underwent PD catheter placement, Crabtree et al reported the necessity for adhesiolysis in 32% of those that had prior stomach surgical procedure (58%), however solely 3.3% in these with out prior stomach surgical procedure. It’s not stunning that they discovered adhesiolysis was wanted extra generally primarily based on the variety of prior operations, starting from 22.7% after one operation to 52% if the affected person had a historical past of 4 or extra operations[19]. Nonetheless, the severity of adhesive illness could solely be evident after tried lysis of adhesions and catheter placement as proven in his research the place the incidence of catheter failure from intensive adhesions was only one.8%. In the same research of 217 catheter insertions, Keshvari discovered a 42.8% incidence of earlier stomach surgical procedure and 27% incidence of adhesions. Intensive laparoscopic adhesiolysis was required in solely 3 sufferers. When evaluating the sufferers who had adhesions and people with out, he discovered no distinction within the incidence of mechanical issues or want for revision[20]. Catheters have additionally been positioned in a suprahepatic location in sufferers with a hostile pelvis precluding low placement of a catheter, and in infants present process open coronary heart surgical procedure with profitable dialysis[21]. Subsequently, historical past of prior stomach surgical procedure will not be a contraindication to attempting peritoneal dialysis if surgeons with expertise in superior laparoscopy can try lysis of adhesions and catheter placement in these sufferers.

2. Lack Of Integrity Of The Stomach Wall

Uncorrected mechanical defects that forestall efficient PD reminiscent of surgically irreparable hernia, omphalocele, gastroschisis, diaphragmatic hernia, pericardial window into the stomach cavity, and bladder extrophy are additionally contraindications, though uncommon exceptions to this rule have been described[22]. The amount of dialysate should dwell within the stomach the place the peritoneum is effectively vascularized. Subsequently these situations forestall correct peritoneal dialysis and should result in fluid leak into the pleural house or comfortable tissues. Due to the elevated intraabdominal strain with peritoneal dialysis, the incidence of stomach wall hernia is nearly 30% in adults and as much as 40% in kids[23, 24]. Literature concerning big stomach wall hernia restore earlier than or throughout peritoneal dialysis is missing. Nonetheless, it’s recognized that hernias can result in issues reminiscent of dialysate leak, edema, ache and incarceration all of which may forestall satisfactory dialysis. Subsequently an intensive examination for hernias is obligatory previous to PD catheter insertion and all hernias ought to be mounted earlier than the initiation of PD. Moreover, laparoscopy permits inspection and identification of occult inguinal hernias or patent processus vaginalis, which can inevitably turn out to be a scientific hernia sooner or later. Though no literature exits concerning concomitant hernia restore and insertion of PD catheter, many consultants recommend fixing these defects when discovered. This will likely require consenting the affected person for attainable hernia restore previous to the laparoscopic insertion process. Comparative trials of open and laparoscopic inguinal hernia restore in PD sufferers don’t exist. Nonetheless, a number of stories have used open polypropylene mesh restore of inguinal hernias and proven very low recurrence and leak charges, regardless of resuming PD inside a number of days[25-28].

For ventral hernias, open anterior restore with inversion of the hernia sac with out disrupting it, and inserting onlay mesh has been proven to have low recurrence and leak charges in adults[29, 30]. If the peritoneum is entered, it is strongly recommended to shut the peritoneum in a water-tight method[31]. Ventral and inguinal hernia restore could also be carried out concomitantly with PD catheter insertion and never delay the beginning of PD[32, 33]. If satisfactory hernia restore will not be profitable, there tends to be fast enlargement and dialysate leak[34, 35], thus these sufferers could not be candidates for PD.

3. Weight problems

Weight problems is included within the Nationwide Kidney Basis Kidney Illness Outcomes High quality Initiative Pointers 2000 as a attainable relative contraindication to peritoneal dialysis. There are issues that sufferers with excessive BMI could have insufficient solute clearance or ultrafiltration. There are additionally issues about elevated threat of catheter leak, exit website infections, and peritonitis. Nonetheless, this isn’t effectively studied within the present literature. It’s useful to exit the catheter above the Pannus, subsequently the usage of prolonged or pre-sternal catheters is beneficial in overweight sufferers however this has not been studied in a randomized managed trial[36, 37].

4. Intraabdominal overseas physique

In sufferers with intra-abdominal overseas materials reminiscent of vascular grafts and ventricular-peritoneal shunt there’s concern about an elevated threat of contamination and graft an infection[38]. Nonetheless, the usage of peritoneal dialysis (PD) could supply appreciable benefits in these sufferers together with higher hemodynamic management and avoidance of anti-coagulation. There have been three retrospective opinions which have proven no important threat in utilizing PD in sufferers with previous historical past of open stomach aortic aneurysm (AAA) restore[39-41]. In actual fact in a single research of 8 sufferers revealed that there have been six episodes of peritonitis with out scientific proof of graft an infection[39]. A assessment by Misra in 1998 concluded that “PD seems to be an environment friendly mode of dialysis with a surprisingly small variety of issues in these sufferers”[42]. The Nationwide Kidney Basis Kidney Illness Outcomes High quality Initiative Pointers 2000 state that it’s suggested to attend 4 months after insertion of intra-abdominal overseas our bodies, reminiscent of stomach vascular prostheses[15]. This will likely turn out to be much less of a difficulty with the emergence of Endovascular AAA restore. There was one printed report of laparoscopic adjustable gastric band within the presence of peritoneal dialysis. Valle et al adopted one PD affected person with a Lap Band ™ for 8 months and famous no infectious issues[43].

A survey of facilities taking part within the Worldwide Pediatric Peritoneal Dialysis Community recognized 18 sufferers with concurrent ventriculoperitoneal shunts and peritoneal dialysis catheters. In 15 of the 18 circumstances, the shunt was in place previous to placement of the dialysis catheter. The incidence of peritonitis was 1/19.6 months, which is kind of just like the 1/18.8 months reported in kids with out shunts[44]. Extra importantly, there have been no episodes of meningitis or ascending shunt infections throughout episodes of peritonitis.

5. Ostomy

Presence of an ostomy has been thought-about by many a contraindication as a result of presumably increased an infection threat[15]. Nonetheless, Korzets et. al. has proven in a small variety of grownup topics that mechanical and infectious issues are moderately low[45]. Some authors have recommended utilizing a pre-sternal exit website in grownup and pediatric sufferers with stomas, nevertheless this has not been studied in a randomized managed trend [37, 46, 47]. There may be inadequate knowledge to make a powerful advice concerning PD within the presence of a stoma; subsequently that call ought to be made on a case by case foundation.

Gastrostomy tubes are generally wanted in pediatric sufferers with renal failure to enhance dietary standing. A single middle assessment of 90 pediatric sufferers on peritoneal dialysis revealed 53.5% had gastrostomy tubes with 60% inserted previous to initiation of dialysis, 21% after onset of peritoneal dialysis, and 18% inserted concurrently the peritoneal dialysis catheter. The an infection charge was increased in sufferers with gastrostomy tubes (0.12 infections/month) as in comparison with these with out (0.07 infections/month) impartial of the timing of placement of the gastrostomy[48]. Placement of a percutaneous endoscopic gastrostomy (PEG) has been related to an elevated threat of peritonitis in kids. A multicenter research recognized 27 kids who had a PEG tube positioned within the setting of peritoneal dialysis. Thirty-seven % developed peritonitis inside every week of placement and two led to loss of life[49]. Ledermann et. al. discovered no enhance in infections in 9 kids who underwent an open gastrostomy, however famous peritonitis in 4 of 5 kids already on peritoneal dialysis with PEG tube placement[50]. A current research evaluated synchronous lap peritoneal dialysis catheter placement with laparoscopic visualization throughout PEG placement and famous just one an infection throughout the first month of placement in a cohort of 10 sufferers and no statistically important enhance in infections in contrast with 23 sufferers who had synchronous open gastrostomy tube placement[51]. Ought to a gastrostomy be required on pediatric sufferers already on peritoneal dialysis, placement by blind PEG method seems to have the next an infection charge and this ought to be thought-about towards a doubtlessly increased dialysate leak charge with open gastrostomy insertion.

6. Incapacity to tolerate common anesthesia

To realize CO2 pneumoperitoneum and visualization of the stomach, common anesthesia was utilized in all of the papers we reviewed utilizing laparoscopic strategies besides two printed sequence utilizing nitrous oxide pneumoperitoneum and native anesthesia[52, 53]. Sufferers with finish stage renal illness typically have a number of medical issues with excessive incidence of vascular and coronary heart illness[54]. Their threat stratification ought to be carried out preoperatively as is routine for any laparoscopic operation below common anesthesia. In sufferers who should not medically cleared for common anesthesia, open and percutaneous insertion strategies, carried out below native anesthesia with or with out sedation ought to be most well-liked. Nitrous oxide pneumoperitoneum below native anesthesia can be an choice the place accessible.

INSERTION OPTIONS

Guideline Advice

  1. For peritoneal entry, blind percutaneous, open surgical, peritoneoscopic, fluoroscopically guided percutaneous, and laparoscopic insertion procedures, when carried out by skilled operators, are possible and secure with acceptable outcomes. (+++ Proof, Robust advice)

Blind Percutaneous

In 1968 Tenckhoff and Schechter described a percutaneous non-visualized methodology of catheter placement. Sadly, this was related to a threat of bowel or vessel harm, in addition to a excessive incidence of malpositioned catheters leading to failure charges of as much as 65% at two years[55]. Nonetheless a number of different stories utilizing the blind insertion method have proven satisfactory outcomes, with dysfunction and leak charges under 7%[56-59] and a bowel perforation threat of 1-2%[57, 59, 60]. Zappacosta had two bowel perforations in sufferers who had prior stomach surgical procedure and subsequently started utilizing percutaneous insertion solely in sufferers who had by no means had stomach surgical procedure[56]. Aksu described percutaneous placement of 108 peritoneal catheters in 93 pediatric sufferers with want for elimination for dysfunction in 14% over the ten 12 months interval of the research, however no circumstances of bowel perforation[61]. Some great benefits of this system are that the catheter could also be inserted on the bedside, ICU or minor surgical suite below native anesthesia for emergent dialysis. Varughese has advisable that this system ought to be used preferentially in low threat sufferers (no prior stomach surgical procedure ) in growing nations the place price is a significant component[62].

Open Surgical

Open placement below direct surgical imaginative and prescient by way of mini-laparotomy was described by Brewer in 1972[63] and as of 2006 was nonetheless essentially the most generally used insertion method. Nonetheless, 2012 Facilities for Medicare & Medicaid Companies (CMS) knowledge exhibits that the estimated use of this system is 27% in america. In 1990 Nicholson et al in contrast closed (percutaneous) insertion (n=163) and open surgical insertion (n=290) by means of a midline incision. They discovered that catheter survival was considerably higher after open insertion than by closed[64]. To enhance the leak charge, Stegmayr described a paramedian incision for entry with muscle splitting and minilaparotomy. The catheter is launched utilizing a stylet and basically blind insertion into the pelvis. A handbag string is used to safe the peritoneum across the catheter to stop leakage. The posterior and anterior fascia can be closed across the catheter. Of 114 sufferers present process catheter insertion utilizing this system there have been no fluid leaks and a dysfunction charge of 4.4%[65]. As of 2004, the about 85% of PD catheters positioned in kids used the open method[66]. Owing to the thinner stomach wall, pediatric catheter placement is usually with a periumbilical midline pores and skin incision however a paramedian fascial incision within the anterior rectus sheath.  After spreading aside the muscle fibers, the posterior sheath is opened, with or with out tunneling behind the rectus, and the catheter inserted over a stylet.  A handbag string suture is used to shut the fascia across the catheter at each the anterior and posterior layers, if attainable[67]. Omentectomy is usually carried out within the pediatric inhabitants and could also be carried out by means of both the umbilical or paramedian incision[66-68]. Since there’s direct visualization of the peritoneum previous to insertion, it might be most well-liked as a manner of avoiding bowel harm in sufferers who’ve had prior stomach surgical procedure[69]. A drawback over percutaneous insertion is the necessity for an accessible surgical group and working room. A bonus over the laparoscopic method which requires common anesthesia is that it may be carried out below native anesthesia and aware sedation. Nonetheless, the primary limitation is as much as a 38% incidence of drainage dysfunction[70]. Two main components which may be concerned in catheter dysfunction are insufficient placement of the catheter tip into the pelvis, which permits the catheter emigrate and turn out to be entrapped throughout the omentum, and the presence of intra-abdominal adhesions, which intervene with appropriate catheter placement and should trigger the PD fluid to loculate[71-74].

Peritoneoscopic

In an try to enhance catheter operate and reduce issues a peritoneoscopic method was described by Ash et al. in 1981[75]. He used a particular needlescope (Y-TEC, Medigroup, Inc. North Aurora, IL) with surrounding cannula and catheter information. The steps of this insertion method embody: Needle trocar and surrounding Quill information or sheath insertion by means of stomach wall adopted by insufflation utilizing a hand pump and room air. A 2.5 mm scope is then superior by means of the Quill information. The operator friends by means of the lens and identifies an open house within the peritoneum, normally pelvis. The scope is eliminated, the information is dilated to six mm and the PD catheter is inserted by means of it. The deep cuff is pushed by means of the Quill information to a place under the anterior rectus sheath utilizing a Cuff Implanter Instrument (Medigroup Inc., Oswego, IL) and the information is eliminated. The catheter is tunneled and pulled out a lateral exit website. This methodology diminished the early failure charge to three% by the writer. Nonetheless, these outcomes weren’t reproduced by Maffei who discovered a 12.5% dysfunction charge in 119 sufferers[76]. Nahman et. al. modified the insertion method by coming into the stomach utilizing a Seldinger method with needle, wire then sheath and dilator, previous to inserting the scope. In a pattern of 82 sufferers the peritoneal cavity was efficiently cannulated in 97.6%. He discovered a leak charge of 4.9% a dysfunction charge of 6.1% and one affected person who had ileal erosion and perforation[77]. Peritoneoscopic insertion is usually carried out by Nephrologists in an outpatient setting or within the ICU and a lot of the current printed knowledge is from exterior america[78-80]. One quoted benefit will not be having to contain a surgeon, working room or anesthesiologist. This has been proven to be essential in some nations the place surgical help is missing[81]. Having a devoted group of interventional nephrologists to put PD catheters can enhance the penetration of PD[80]. One other profit is visualization of the peritoneum and extra precise placement of the tip of the catheter than with blind percutaneous or open surgical. Nonetheless, this system doesn’t permit for adhesiolysis, requires specialised gear and experience and has a threat of vascular and bowel harm on insertion[82]. Its use has fallen to lower than 1% in america as of 2012.

Fluoroscopically Guided Percutaneous

Fluoroscopically guided percutaneous PD catheter insertion has been reported in a number of massive research over the past decade and is one other viable choice relying on native experience. A needle (blunt tip or Veress) is used within the left decrease quadrant, typically below ultrasound steerage to keep away from the inferior epigastric artery[83]. A wire is inserted and guided into the pelvis below fluoroscopy. A sheath and dilator is then positioned, adopted by the catheter. The distal cuff is positioned within the rectus sheath and the catheter is tunneled and introduced out a separate stab incision. A number of retrospective opinions have proven comparable complication charges to open surgical insertion with failure charges between 0 and 5%[84-87]. Nonetheless, most of those research solely included sufferers who’ve by no means had stomach surgical procedure. Some great benefits of this system are that it avoids the potential longer ready occasions for surgical insertion, in addition to the upper price of an working room and threat of common anesthesia. There may be additionally doubtlessly much less trauma to the affected person. The disadvantages aren’t any direct visualization of the peritoneal cavity or lysis of adhesions, subsequently doubtlessly poorer outcomes in sufferers who’ve had prior stomach surgical procedure[85, 88].

Laparoscopic Insertion

Laparoscopic insertion of PD catheters was first described within the early Nineteen Nineties and the security and feasibility of varied laparoscopic insertion strategies in each adults and youngsters have been documented in lots of case stories, retrospective opinions and comparative research[52, 68, 89-121]. Its use has grown steadily and it’s now the method utilized in about 50% of PD catheter insertions in line with CMS knowledge. The early stories employed pneumoperitoneum and laparoscopy to visualise the catheter as it’s inserted into the peritoneum and this has been known as “primary laparoscopic method” within the literature. Subsequent stories used two or three port strategies to carry out lysis of adhesions throughout insertion and manipulate the catheter tip into the pelvis[111, 122]. Maybe the best good thing about laparoscopy in these circumstances is to facilitate adjunct strategies to assist decrease catheter dysfunction. The first causes of catheter dysfunction are compartmentalization from adhesions, catheter tip migration into the higher stomach and omental wrapping or entrapment. To immediately deal with these points, others started incorporating suture fixation of the catheter or rectus sheath tunneling to stop migration and omentopexy or omentectomy to maintain the omentum away from the catheter tip. The usage of these measures has been known as “superior laparoscopic strategies” and will probably be detailed subsequent[115].

ADVANCED LAPAROSCOPIC TECHNIQUES TO AVOID CATHETER DYSFUNCTION

Guideline Advice

  1. Laparoscopic lysis of adhesions ought to be included to cut back catheter dysfunction. (+++ Proof, Robust advice)
  2. Laparoscopic suture fixation of the PD catheter could scale back catheter dysfunction however extra proof is required. (++ Proof, Weak advice)
  3. Rectus sheath tunneling helps forestall migration and could also be superior to suture fixation because it doesn’t require added ports and devices. (++ Proof, Weak advice)
  4. Omentopexy in adults is a secure adjunct to laparoscopic PD catheter insertion and ought to be included both routinely or selectively to cut back catheter dysfunction. (+++ Proof, Weak advice)
  5. Omentectomy ought to be thought-about in pediatric sufferers present process peritoneal dialysis catheter placement (++ Proof, Weak advice)
  6. The mixture of lysis of adhesions, rectus sheath tunneling and omentopexy together presents the bottom charge of postoperative PD catheter dysfunction and ought to be a most well-liked method in adults. (+++ Proof, Robust advice)

Lysis of Adhesions

Peritoneal adhesions, normally from prior surgical procedure are a significant component in PD catheter dysfunction attributable to compartmentalization of the peritoneal cavity. The laparoscopic strategy permits identification and lysis of important adhesions, though it might contain including one other one or two ports[90, 123]. Lysis of adhesions will be carried out utilizing ultrasonic shears if bleeding is a threat, or chilly scissors[88]. It was employed in 9 out of the ten massive case sequence we reviewed[95, 106-111, 114, 124] and has been proven by Crabtree and Keshvari to permit comparable catheter operate charges in sufferers who’ve had stomach surgical procedure as these with a virgin stomach[19, 20]. Though no research particularly in contrast PD catheter placement and lysis of adhesions to PD catheter placement alone, lysis of adhesions is taken into account important in lowering catheter dysfunction.

Suture Fixation

The intraperitoneal portion of the catheter features finest when within the pelvis. Subsequently, catheter tip migration away from the pelvis is a standard cause for catheter failure[71]. One strategy to forestall migration is suturing of the catheter tip to the bladder, uterus or pelvic sidewall and this has been reported by a number of authors[91-93, 106, 107, 112, 124, 125]. This normally requires one other trocar to put the suture. There have been, nevertheless, stories of suture fixation stopping straightforward catheter elimination in addition to being a possible explanation for inside hernia or adhesions[126]. It could additionally impair the pure capability of the catheter to “float” to the biggest space of PD fluid. Bar-Zoar and Lu confirmed a comparatively excessive dysfunction charge after suture fixation of 14% and 12% respectively[107, 124]. Nonetheless, Ko reported a 2.6% migration charge[106] and Soontrapornchai in contrast 50 sufferers who had open surgical procedure with 52 sufferers who had laparoscopic insertion and suture fixation to the pelvis sidewall. He confirmed 12% migration charge with open and none with laparoscopic, though the dysfunction charges have been 4 and 6% respectively[112]. In a assessment article by Frost et al, it was advisable that “correct rectus sheath tunneling and placement of the deep cuff are the important thing to lowering catheter tip migration” (not suture fixation)[126]. Nonetheless, randomized trials evaluating catheter insertion with and with out suture fixation or evaluating suture fixation to rectus sheath tunneling haven’t been carried out.

Rectus Sheath Tunneling

Rectus sheath tunneling, additionally described as extraperitoneal or preperitoneal tunneling, has been utilized by many authors as a strategy to preserve a pelvic orientation and stop catheter migration[52, 108, 110, 113, 127]. The method includes visualizing the insertion gadget (sheath, blunt trocar or grasper) because it comes by means of the rectus muscle however earlier than it enters the peritoneal cavity. As soon as the gadget is seen simply above the posterior rectus sheath and peritoneum, it’s tunneled 4-6 cm towards the midline pelvis earlier than really penetrating and coming into the peritoneal cavity. Some have advocated suture fixation across the catheter on the anterior rectus sheath to additional inhibit fluid leak[113]. This lengthy tunnel can forestall motion of the tip to the higher stomach and has been proven to lower fluid leak. As well as, this system has the benefit over suture fixation of not requiring further trocars for suturing. 5 research utilizing laparoscopic insertion and rectus sheath tunnel confirmed dysfunction charges between 4% and eight.6% and leak charges from zero to 12.5%[52, 108, 110, 113, 127].

Omentopexy and omentectomy

The omentum has been a recognized supply of catheter dysfunction[74]. In the course of the period of open surgical procedure, omentectomy was described in adults and youngsters as a strategy to scale back this complication. The omentum was pulled up by means of the incision and excised. As an alternative of eradicating omentum, McIntosh sutured it to the higher stomach wall as omentopexy[128]. Though it’s attainable to do omentectomy throughout laparoscopic PD catheter insertion[97, 125], it provides to the process time, requires a bigger incision and has a threat of bleeding[95]. Subsequently, omentopexy appears to be favored within the literature. Laparoscopic omentopexy has been used routinely by Ogunc [94, 114, 127] or selectively by Crabtree, Attaluri and Haggerty in circumstances the place the omentum extends into the pelvis[95, 113, 129, 130]. Omentopexy strategies embody an anchoring suture within the higher stomach utilizing a transabdominal suture passer, anchoring sutures to the proper and left higher stomach wall utilizing intracorporal suturing, and utilizing a everlasting tacking gadget to the stomach sidewall. Goh described an omenal folding method the place the omentum was folded onto itself in a cephalad path utilizing silk sutures, shortening it[131].

The pediatric literature acknowledges that catheter occlusion attributable to omental wrapping is extra widespread in kids than in adults[132]. A survey of 156 pediatric surgeons in 2004 revealed routine omentectomy was carried out by 59% of respondents[66]. Two smaller research discovered decreased catheter occlusion charges in kids with omentectomy (4.5% and 19%) than in these with out omentectomy (22.7% and 36%, respectively), however these didn’t attain statistical significance[133, 134]. A bigger research with 207 pediatric sufferers famous on multivariate evaluation that lack of omentectomy was related to practically double the reoperative charge for an infection or malfunction[135]. A further assessment of 163 kids with peritoneal dialysis catheters revealed a big discount in catheter failure charge from 23% to fifteen% when omentectomy was carried out[136]. A research of 26 pediatric sufferers present process laparoscopic catheter placement revealed catheter survival within the 9 sufferers present process omentectomy was 8 months, in comparison with 5.8 months in these retaining their omentum. Nonetheless, statistical evaluation was not carried out to find out the importance[125]. Based mostly on this knowledge, omentectomy ought to be thought-about in pediatric sufferers present process peritoneal dialysis catheter placement.

Mixed strategies

Each Ogunc and Crabtree have printed dysfunction charges of zero and 0.5% respectively when utilizing rectus sheath tunneling and omentopexy[115, 127]. Moreover, after incorporating rectus sheath tunneling and selective omentopexy for all laparoscopic PD catheter insertions, Attaluri discovered a main dysfunction charge of 4.5% in 129 sufferers utilizing a mixture of strategies versus 36.7% when utilizing primary laparoscopy[113]. Though prime quality proof is missing, there’s minimal added threat and in restricted research, important profit in combining lysis of adhesions, omentopexy and rectus sheath tunneling when performing laparoscopic PD catheter insertion.

PERIOPERATIVE CONSIDERATIONS

Guideline advice

  1. Presurgical evaluation ought to embody thorough examination for hernias and the catheter exit website ought to be marked earlier than surgical procedure. (+ Proof, Weak advice)
  2. A necessity for preoperative bowel preparation has not been conclusively demonstrated and additional proof is required earlier than a advice will be offered
  3. Prophylactic antibiotics ought to be used previous to laparoscopic insertion of PD catheter. Vancomycin could also be superior to first era cephalosporins in minimizing early peritonitis after PD insertion. Nonetheless its routine ought to solely be thought-about primarily based on native resistance patterns and outcomes. ( +++ Proof, Robust advice)

Pre-surgical Evaluation

Pre-surgical evaluation of a affected person present process laparoscopic insertion of a PD catheter ought to embody thorough examination trying to find hernias since these could also be repaired on the time of insertion. Marking the exit website with the affected person sitting or standing has been recommended in Scientific Apply Pointers for Peritoneal Entry in the UK and Flanigan’s replace on the ISPD Pointers towards optimum peritoneal entry[69, 137]. These suggestions have been formulated by a panel of consultants. As well as, the usage of stencils to mark the exit website whereas sufferers have been sitting, standing and mendacity has been reported to lower the incidence of cuff extrusion[138].

Bowel preparation

The usage of bowel preparation previous to laparoscopic insertion of PD catheters has not been studied effectively. On condition that constipation is a recognized explanation for catheter dysfunction, to optimize peritoneal entry a night laxative previous to surgical procedure has been recommended [137].

Antibiotics

Preoperative prophylaxis with intravenous antibiotics is advisable for PD catheter insertion by the Worldwide Society of Peritoneal Dialysis (ISPD) Pointers for peritoneal dialysis-related infections and European Finest Apply Guideline for Peritoneal Dialysis [139, 140]. A scientific assessment of 4 randomized managed trials concluded that the usage of perioperative intravenous antibiotic prophylaxis in contrast with no remedy considerably diminished the danger for early peritonitis (< 1 month from insertion: 335 sufferers; RR, 0.35; 95% CI, 0.15 to 0.80) however not the danger of exit-site and tunnel an infection. It has been advisable {that a} single dose of first or second era cephalosporin be given and that vancomycin not be used routinely to keep away from growth of vancomycin resistant enterococcus[137]. Nonetheless a subsequent randomized managed trial by Gadallah and others that in contrast three preoperative antibiotic regimens discovered that throughout the first 14 days, peritonitis developed in 1 affected person (1%) within the Vancomycin group in comparison with 12 sufferers (12%) within the management group (no antibiotics; p = 0.002), and in 9 sufferers (9%) within the Cefazolin group (p = 0.68 in comparison with management group). Present scientific observe pointers from the Worldwide Society of Peritoneal Dialysis and Pointers from a UK working group have advisable that Vancomycin be thought-about for prophylaxis primarily based on native outcomes, weighing the potential advantages versus the danger of number of resistant organisms and growth of clostridium difficile colitis[69, 139].

SURGICAL TECHNIQUE

Guideline Advice

  1. Peritoneal entry throughout lap PD insertion ought to be obtained away from earlier scars; surgeons ought to use the method they’re most comfy and skilled with. ( ++  Proof, Weak advice)
  2. The surgeon ought to decrease the dimensions and variety of ports used and place them in a fashion that optimizes visualization of the catheter peritoneal insertion level and the pelvis. (++  Proof, Weak  advice)
  3. When inserting the PD catheter by means of the stomach wall, the deep cuff ought to be positioned contained in the rectus sheath. (++ Proof, Robust advice).
  4. The superficial PD catheter cuff ought to be 2 cm from the pores and skin exit website in kids and no less than 2 cm in adults to stop future cuff extrusion. (+ Proof, Weak advice)

Peritoneal Entry

Entry to the peritoneal cavity has been completed by open Hassan trocar, subcostal Veress needle insertion or supraumbilical Veress needle insertion with equal efficacy. In sufferers with prior stomach incision, closed entry away from the midline or open method is advisable for security. In a assessment by Crabtree, he famous that 43% of authors used a periumbilical website. He advisable avoidance of the umbilical entry level as a result of threat of hernia and the potential for poor visualization when the digicam is simply too near the insertion level[88]. From the accessible literature, we conclude that entry ought to be gained on the discretion of the working surgeon.

Tools

Normal laparoscopes of thirty diploma, zero diploma, 3, 5 and 10 mm have all been used within the research reviewed. There isn’t any normal variety of ports as one, two and three port strategies have been described of varied sizes and kinds. Graspers and scissors ought to be accessible in addition to ultrasonic dissecting devices since lysis of adhesions is usually needed. Omentopexy requires a suture passing needle reminiscent of Endoclose ™ (Covidian, Norwalk, CT), Carter-Thompson gadget or laparoscopic suturing gear and nonabsorbable suture. Mini-laparoscopic devices have additionally been used with equal success[95, 127, 141-143]. Regardless of the paucity of publications evaluating leak charges and the dimensions of trocars, most authors suggest the smallest ports accessible in a non-cutting selection to permit the quickest therapeutic of the peritoneum, thus facilitating early begin of PD and low leak charge.

Catheter choices

Generally used catheters are silicone and have a pig tail or straight configuration internally. Pig tail catheters are typically favored extra in adults than kids. Moreover, they normally have two cuffs to stop dislodgement and an infection[139]. Nonetheless, single cuff catheters are used selectively in small infants. Suggestions concerning the precise sort of catheter to make use of should not throughout the scope of this guideline.

Trocar place

In each grownup and pediatric sufferers, trocar place diversified among the many papers reviewed. Usually one port is used for the digicam within the mid or higher stomach and no less than yet one more lateral port is used for greedy devices. Minimizing ports could lower the dialysate fluid leak however this has not been studied in randomized managed trials.

Insertion by means of the stomach wall

Almost about the insertion of the catheter by means of the stomach wall, there are numerous decisions. Some have used a ten mm trocar normally with a handbag string and the catheter is pushed in or pulled out with a greedy instrument. The 8 mm Step Trocar System (Covidian, Norwalk, CT) has been used extensively because it’s diameter permits the cuffed catheter to slip by means of after which the trocar is eliminated[110, 113]. Others use a peel aside sheath and dilator (Quinton, Tyco Healthcare Group LP, Mansfield, MA ) or a Quill catheter information and cuff implanter (Medigroup corp. Oswego Illinois). In the course of the implantation the deep cuff is positioned in between the anterior and posterior rectus sheaths. Most, however not all authors proceed to put a fascial pursestring suture across the catheter in pediatric sufferers to lower the incidence of leak[67, 89, 121, 144].

Exit website and subcutaneous tunnel

After the deep cuff is positioned, the tip of the catheter is tunneled subcutaneously to an exit website within the lateral stomach wall. Directing the tunnel inferiorly has been proven to presumably scale back the danger of catheter associated peritonitis in adults and youngsters[139]. Presternal exit websites have been described for youngsters and adults with stomas, incontinence, weight problems or different physique habitus issues[36, 47]. In adults, care is taken to verify the superficial cuff is 2 cm or better from the exit website to stop cuff extrusion sooner or later[88, 139]. In kids it’s positioned at 2 cm[144]. In adults and youngsters, suturing the catheter to the pores and skin is discouraged attributable to threat of irritation and an infection. Nonetheless, the catheter ought to be anchored near the exit with both a dressing or commercially accessible immobilization gadget till fibroblast ingrowth on the Dacron cuff can sufficiently fixate the catheter (minimal 2-3 weeks)[144].

Intraoperative catheter trial

On the completion of the catheter implantation, it’s normal to carry out an intraoperative catheter trial to doc satisfactory influx and outflow. Between 250 ml and 1000 ml in adults and 10 ml/kg in kids have been used within the literature [95, 111, 145].

POSTOPERATIVE PROTOCOL

  1. Minimizing dressing adjustments and dealing with could also be helpful within the first two postop weeks. (+ Proof, Weak advice)
  2. Satisfactory time ought to be given after surgical procedure for therapeutic earlier than PD is initiated and the present normal is 2 weeks. A extra pressing begin ought to be thought-about when the advantages outweigh the dangers (++ Proof, Weak advice)

Dressings

The European finest observe guideline for peritoneal dialysis and the consensus pointers for the prevention and remedy of catheter-related infections and peritonitis in pediatric sufferers receiving peritoneal dialysis suggest {that a} dressing ought to be positioned on the time of surgical procedure and maintained all through the therapeutic part. The dressing shouldn’t be modified greater than as soon as every week throughout the first two weeks until bleeding happens or an infection is suspected[140, 144].

Optimum time to begin dialysis

The timing of graduation of dialysis after catheter insertion has not been studied in randomized managed trials, though one is at the moment underway in Australia[146]. Based mostly on stage three and 4 proof, the Kidney Well being Australia Caring for Australisans with Renal Impairment (CARI) pointers recommend that “when attainable, peritoneal dialysis shouldn’t be commenced till no less than 2 weeks after the insertion of the dialysis catheters”[147]. The ISPD and European dialysis and transplant association-European renal affiliation additionally recommend a 2 week therapeutic time previous to beginning peritoneal dialysis for each adults and youngsters[69, 148]. Nonetheless, pressing begin (lower than two weeks) peritoneal dialysis is gaining recognition in america. In a research of 18 pressing begin sufferers versus 9 non-urgent begin sufferers, there was not a statistically important distinction in minor or main leak charges, though the pressing begin group had two versus zero main leaks[149]. In a randomized managed trial by Track et. al. after blind percutaneous insertion the early leakage charges have been comparable (9.5% vs. 10.5%) between fast begin PD with 2 Liters of dialysate and delayed begin with gradual enhance in fluid quantity[150].

ADULT OUTCOMES

The first final result measure in our assessment is early and late dysfunction requiring elimination or surgical repositioning. Dialysate leak is a standard secondary final result. We additionally in contrast perioperative issues reminiscent of bleeding and perforation which can differ primarily based on the insertion method. Outcomes from massive sequence in adults utilizing numerous strategies are introduced in Desk 3. Within the following part, comparative research are mentioned intimately.

Desk 3. Outcomes from massive sequence in grownup sufferers
Insertion Approach Creator Yr No. Prior surgical procedure Dysfunction Leak Bleeding Perforation
Blind percutaneous Zappacosta[56] 1991 101 Excluded 4% 3% 0 2%
Mellotte [60] 1993 50 Not acknowledged 12% 20% 6% 0
Allon [59] 1998 154 Excluded 6.5% 5% 0 0
Napoli [57] 2000 451 Not acknowledged 6.7% 6.8% 3% 1.5%
Banli [58] 2005 42 Excluded 4.8% 4.8% 0 0
Open surgical Rubin [70] 1982 123 Not acknowledged 38% 20% 0 0
Robison [151] 1984 173 Not acknowledged 6% 5% 0 0
Bullmaster [72] 1985 115 Not acknowledged 19.1% 7% 0 0
Cronen [71] 1985 110 Not acknowledged 22% 12% 0 0
Stegmayr [152] 1993 114 Not acknowledged 4.4% 1% 0 0
Peritoneoscopic Adamson [153] 1992 100 14% 4% 7% 3% 1%
Nahman [77] 1992 82 Not acknowledged 6% 4.9% 0 1.2%
Copley [154] 1996 136 Not acknowledged 7.4 3.7 0 0
Kelly [79] 2003 40 Not acknowledged 2.5% 2.5% 0 0
Goh [80] 2008 91 Not acknowledged 17.6% NR 0 0
Fluro guided percutaneous Zaman [155] 2005 36 Not Said 3% 3% 3% 0
Vaux [84] 2008 209 Excluded 7% 5% 0
Moon [86] 2008 134 Excluded 1.5% 3% 0.7% 0
Reddy [87] 2010 64 Not Said 4.7% 1.6% 0 0
Primary Laparoscopic Poole [111] 2000 53 Included 2% 2% 2% 2%
Draganic [117] 2001 30 50% 3.3 3.3% 0 0
Gajjar [120] 2007 45 31% 2.3% 11% 0 0
Maio [109] 2008 100 9% 6% 5% 0 0
Jwo [119] 2010 37 10.8% 11% 18.9% 0 0
Superior Laparoscopic * Tsimoyiannis [156] (s) 2000 25 Included 0 0 0 0
Lu [124] (s) 2003 148 Not acknowledged 14% 0 5% 0
Soontrapornchai [112] (s) 2005 50 Excluded 6% 2% 2% 0
Bar-Zoar[107] (s) 2006 34 26% 11.6% 3% 0 0
Schmidt [108] (t) 2007 47 Not acknowledged 6.4 12.8% 0 0
Haggerty[95] (o) 2007 33 60% 6.5% 0 0 0
Ko [106] (s) 2009 38 Included 0 0 0 0
Keshavari [52] (t) 2009 175 Not acknowledged 8.5% 7.4% 0.6% 0
Superior Laparoscopic ** Crabtree [110] 2009 428 57% 3.7% 2.6% 0 0
Attaluri [113] 2010 129 Included 4.6% 0 0 0
Ogunc [127] 2005 44 20.5% 0 0 0 0

Dysfunction – outlined as catheter dysfunction requiring elimination, alternative or revisional surgical procedure
* Incorporating lysis of adhesions and both catheter fixation or omentopexy
t = peritoneal tunnel
s = suture fixation
o = omentopexy
**  Incorporating lysis of adhesions, peritoneal tunnel and omentopexy

SUMMARY OF OUTCOMES BY SURGICAL PROCEDURE

A abstract of outcomes by surgical process is introduced in Desk 4. Abstract of outcomes in adults

Papers Prior surgical procedure Dysfunction Leak Perforation
Blind Percutaneous 5 Excluded 3/5 4-12% 3-20% 0-2%
Open 5 Not acknowledged 4.4-38% 1-20% 0
Peritoneoscopic 5 0-14% 2.5-17.6% 3-4.9% 0-1.2%
FGP 5 Excluded 2/5 1.5-7% 1.6-5% 0
Primary Lap 5 9-50% 2-11% 2-18.9% 0-2%
Superior Lap suture fixation 5 0-26% 0-14% 0-12.8% 0
Superior Lap peritoneal tunnel 2 Not acknowledged 6.4-8.5% 7.4-12.8% 0
Superior Lap peritoneal tunnel and omentopexy 3 0-60% 0-4.6% 0 0
  1. Blind percutaneous PD catheter insertion has acceptable malfunction and leak charges in contrast with open insertion in sufferers who’ve by no means had prior stomach surgical procedure. The method could also be particularly helpful in high-risk sufferers for common anesthesia as it may be carried out on the bedside, below native anesthesia by educated nephrologists. Nonetheless, bowel perforation and bleeding threat ought to be thought-about (+++ Proof, Weak advice) 
  2. Open surgical insertion continues to be a normal to which others are in contrast. It’s secure (low perforation charge) and efficient and will be carried out below native anesthesia and sedation. It seems to have increased leak and dysfunction charges in comparison with picture guided percutaneous and superior laparoscopic insertion. (+++ Proof, Weak advice) 
  3. Peritoneoscopic insertion is a method used worldwide, largely by “interventional” nephrologists. It has been studied in sufferers who’ve had prior surgical procedure, however there’s no less than a 1% perforation charge. It seems to be corresponding to open surgical insertion in skilled arms, however has not been in comparison with laparoscopic and fluoroscopic guided percutaneous insertion. (++ Proof, Weak advice)
  4. In sufferers with out prior stomach surgical procedure, percutaneous fluoroscopic PD catheter insertion ends in comparable or higher complication charges and dysfunction charges in comparison with open or primary laparoscopic insertion, and avoids common anesthesia. (+++ Proof, Weak advice)
  5. Primary laparoscopic insertion with out utilizing strategies to attenuate catheter dysfunction ends in comparable dysfunction charges as open insertion. (+++ Proof, Robust advice) 
  6. Superior laparoscopic PD catheter insertion utilizing lysis of adhesions, catheter fixation ideally with rectus sheath tunnel, and omentopexy carried out together has the bottom reported charge of catheter dysfunction in adults, even in sufferers with prior stomach surgical procedure. (+++ Proof, Robust advice)

Blind percutaneous vs. open surgical

Mellotte carried out a retrospective assessment in 1993 evaluating percutaneous insertion of fifty PD catheters versus 180 catheters positioned utilizing open surgical procedure. The percutaneous catheters have been positioned on pressing foundation in sufferers not match for anesthesia. That group had considerably increased leak charges 20% vs. 9.3%, P<0.05 and better catheter dysfunction 12% vs. 5.6%. Bleeding and exit website an infection was comparable they usually concluded that percutaneous PD catheter placement is secure and dependable and particularly suited to sick sufferers who wouldn't tolerate common anesthesia[60]. One other retrospective assessment of 215 PD catheter insertions by Ozener was printed in 2001. 100 thirty three have been positioned percutaneously by nephrology workers whereas 82 have been positioned by surgeons utilizing an open method. Sufferers with prior stomach surgical procedure weren't thought-about for peritoneal dialysis. They discovered comparable issues in these two teams, (catheter malfunction 8.86% vs. 12.63%, p=0.12)[157]. In 2012 Medani printed a retrospective evaluation of 313 PD catheters positioned surgically (N=162) and percutaneously (N=151). Sufferers with a historical past of stomach surgical procedure apart from appendectomy or cesarean part weren't candidates for the blind percutaneous insertion methodology. They discovered no statistically important variations between the teams in poor preliminary drainage (9.9 vs. 11.7 %, p=0.1) or secondary drainage failure (7.9 vs. 12.3%, p=0.38). Nonetheless they did discover extra exit website leaks within the percutaneous teams (20.55 vs. 6.8%, p=0.002)[158]. In abstract, blind percutaneous PD catheter insertion has acceptable malfunction and leak charges in contrast with open insertion in sufferers who've by no means had prior stomach surgical procedure. The method could also be particularly helpful in high-risk sufferers for common anesthesia as it may be carried out on the bedside, below native anesthesia by educated nephrologists. Nonetheless, bowel perforation and bleeding threat ought to be thought-about.

Peritoneoscopic vs. open surgical

A potential nonrandomized research evaluating open surgical insertion versus peritoneoscopic was carried out by Pastan in 1991 on a complete of 88 sufferers. He discovered no important distinction in early and late leaks and exit website infections. The catheter survival was considerably longer within the peritoneoscopic group. Causes for elimination have been catheter dysfunction and an infection requiring elimination and no differentiation was made between the 2[159]. Gadallah carried out a randomized managed trial evaluating the result of 76 sufferers in whom the PD catheters have been positioned peritoneoscopically with that of 72 sufferers in whom the catheters have been positioned surgically. Early peritonitis episodes (inside 2 weeks of catheter placement) occurred in 9 of 72 sufferers (12.5%) within the surgical group, versus 2 of 76 sufferers (2.6%) within the peritoneoscopy group (P = 0.02). This increased charge of an infection was probably associated to the next exit website leak within the surgical group (11.1%) as in contrast with the peritoneoscopy group (1.3%). Furthermore, peritoneoscopically positioned catheters have been discovered to have higher survival (77.5% at 12 months, 63% at 24 months, and 51.3% at 36 months) than these positioned surgically (62.5% at 12 months, 41.5% at 24 months, and 36% at 36 months) with P = 0.02, 0.01, and 0.04, respectively[160]. In distinction, Eklund reviewed 108 catheters in a nonrandomized research of 65 sufferers having PD catheter insertion utilizing peritoneoscopic strategies versus 43 utilizing open surgical strategies. He discovered the next charge of incorrect placement and omental obstruction (4.6% vs. 0%) and leakage (13.8% vs. 2.3%) within the peritoneoscopic group. They concluded that surgically positioned PD catheters seem to have an extended survival time than peritoneoscopically positioned ones[78]. In abstract, peritoneoscopic insertion is a method used worldwide, largely by “interventional” nephrologists. It has been studied in sufferers who’ve had prior surgical procedure, however there’s no less than a 1% perforation charge. In skilled arms it seems to have comparable if not higher outcomes in comparison with open surgical insertion, however has not been in comparison with laparoscopic or fluoroscopic guided percutaneous insertion.

Open vs. fluoroscopic guided percutaneous placement

The biggest retrospective cohort evaluation evaluating open surgical insertion to fluoroscopically guided percutaneous insertion in 101 sufferers, revealed no important distinction in issues or catheter malfunction. Nonetheless, this sequence solely included sufferers with no prior stomach surgical procedure. The open surgical group N=49 tended to have extra issues than the percutaneous group N=51; Leakage 13% vs. 4%, p = 0.093, malfunction 11% vs. 9%, p = 0.73 and bleeding 8% vs. 2%, p = 0.21[161]. One current research in contrast open surgical insertion and percutaneous fluoroscopic in a randomized managed trial and located no distinction in a single 12 months catheter survival. It was not acknowledged whether or not sufferers with prior stomach surgical procedure have been excluded. The surgical group had considerably extra bleeding issues (13.3 vs. 3.2%, p < 0.0001). Early catheter malposition was comparable in every group (6%) however the late dysfunction charge attributable to omental wrapping was considerably increased within the surgical group (13.3 vs. 2.9%, p<0.0001). The imply working time was additionally longer within the surgical group[162].

Primary Laparoscopic vs. fluoroscopic guided percutaneous placement

Voss carried out a randomized managed trial evaluating FGP catheter insertion vs. primary laparoscopic in 2012. Sufferers with weight problems, earlier stomach surgical procedure and historical past of adhesions have been excluded. A complete of 113 sufferers have been randomized. They discovered the next charge of early leakage within the surgical procedure group at 1 12 months follow-up (17.9% vs. 7%, p=0.08). Charges of exit website and tunnel infections have been comparable however peritonitis was extra widespread within the laparoscopic group. Dysfunction charges and catheter survival have been comparable whereas the laparoscopic group had virtually twice the hospital price[163].

To summarize, percutaneous fluoroscopic PD catheter insertion presents a low price choice of catheter insertion when consultants can be found. In sufferers with out prior stomach surgical procedure, this methodology of insertion ends in comparable or higher complication charges and dysfunction charges in comparison with open or primary laparoscopic insertion, and avoids common anesthesia. Randomized managed trials evaluating this to superior laparoscopic insertion in sufferers with out prior stomach surgical procedure are wanted to make clear the very best method in these sufferers.

Open vs. primary laparoscopic

Two early retrospective research evaluating laparoscopic and open insertion of PD catheters confirmed a pattern towards decrease issues and dysfunction with the laparoscopic group, however didn’t attain statistical significance [117, 118]. A retrospective research by Gajjar evaluating 30 open PD catheter placements to 45 easy laparoscopic placements and lysis of adhesions confirmed a right away practical success of 97.8% within the laparoscopic group versus 80% within the open group (p =0.014) though 31% of the laparoscopic sufferers had prior stomach surgical procedure versus 16% of the open sufferers. The incidence of exit website leak was comparable 11% vs. 13%[120]. Wright et. al. in contrast 24 sufferers utilizing open insertion with 21 laparoscopic insertions in a randomized potential trial. They discovered increased incidence of early fluid leak within the laparoscopic group 9.5% vs. 0% and no distinction in mechanical dysfunction. The incidence of prior surgical procedure was 20.8% vs. 52%, laparoscopic vs. open[116]. Moreover, a potential randomized research by Jwo evaluating open insertion and insertion utilizing primary laparoscopic strategies and lysis of adhesions confirmed an enchancment in early migration with laparoscopy (2.7% vs. 15%, P=0.110) however increased late migration charges (8.1 vs. 2.5%, p=0.346). There was additionally the next charge of pericannular bleeding within the laparoscopic group (21.5% vs. 7.5%, p=0.077 and comparable charges of dialysate leak. They concluded that laparoscopic insertion was not price efficient and suggest standard open surgical procedure for many sufferers needing main catheter placement[119]. A scientific assessment and meta-analysis by Xie in 2012 concluded that laparoscopic catheter placement has no superiority over open surgical procedure. Nonetheless this research included a trial in pediatric sufferers, trials utilizing peritoneoscopic insertion and the above trials utilizing primary laparoscopic strategies. In addition they concluded that “sooner or later, superior laparoscopy utilizing extra refined procedures could scale back issues in catheterization”[164]. There’s a multicenter randomized managed single-blind trial at the moment underway in Europe to match laparoscopic versus open peritoneal dialysis catheter insertion however it was not acknowledged whether or not this incorporates superior laparoscopic strategies[165].

Superior laparoscopic strategies

In 2000 one other randomized managed trial evaluating open insertion below native with three port laparoscopic insertion below common anesthesia. Their method included suture fixation of the catheter to the bladder or peritoneum. 5 of the laparoscopic sufferers underwent lysis of adhesions. They discovered that the imply working time was longer within the laparoscopic group, 22 vs. 29 min, p < 0.001. Extra importantly, the speed of fluids leak and tip migration have been considerably decrease within the laparoscopic group (32% vs. 0%, p < 0.005 and 20% vs. 0%, p < 0.005)[156]. Ogunc in 2003 was one of many first to match open surgical procedure and laparoscopic insertion in 42 sufferers utilizing omental fixation (omentopexy). He discovered a zero mechanical dysfunction charge with this system versus 23.8% after open insertion (p < 0.05). He concluded this was a profitable methodology of stopping obstruction attributable to omental wrapping with a greater catheter survival[114]. Likewise, Soontrapornchai in contrast 52 sufferers who underwent open insertion and 50 sufferers who had laparoscopic insertion with suture fixation of the tip of the catheter into the pelvis. He discovered that catheter dysfunction from migration was decrease within the lap group (12% vs. 0%, p=0.027) however the working occasions have been longer (65 vs. 29 min., p<.001)[112]. In 2005 Ogunc printed outcomes from a potential research of 44 consecutive sufferers who underwent laparoscopic PD catheter insertion utilizing the mixture of lysis of adhesions, rectus sheath tunneling and omentopexy. 20% had a historical past of earlier stomach surgical procedure and half of these required lysis of adhesions. Peritoneal dialysis was began inside 24 hours and there have been no leaks, no episodes of dysfunction and no main issues after a median follow-up of 17.4 months[127]. Crabtree printed a big comparative research of three teams. An open group (N=63), a primary laparoscopic group, (N=78) and a complicated laparoscopic group, (N=200). This group included rectus sheath tunneling as a manner of stopping migration, selective omentopexy and selective lysis of adhesions. He discovered catheter obstruction charges of 17.5%, 12.8% and 0.5% respectively (p < 0.0001). There have been comparable charges of pericannular leaks of about 2%[115]. His findings have been corroborated by a research of 197 sufferers by Attaluri on the Cleveland Clinic in 2010. Within the superior group of 129 sufferers, they used a 4-6 cm rectus sheath tunnel and selective omentopexy when the omentum was discovered to lie throughout the pelvis/retrovesical house (53.5% of sufferers of their sequence). They discovered a 4.5% main dysfunction charge on this group versus 36.7% within the 68 sufferers who had catheters positioned with out these extra measures (p < 0.0001). As well as, there was just one case of exit website leak (0.51%) presumably as a result of rectus sheath tunneling[113]. In abstract, there was no standardization worldwide concerning primary or superior laparoscopic insertion of PD catheters. There may be important proof that primary laparoscopic insertion ends in comparable dysfunction charges as open insertion. The addition of omentopexy has not been studied by itself however seems to decrease the incidence of catheter dysfunction. Suture fixation and rectus sheath tunneling can restrict migration and the latter requires much less extra ports and instrumentation. Combining lysis of adhesions, catheter fixation with lengthy rectus sheath tunnel, and omentopexy considerably reduces catheter dysfunction when in comparison with open insertion and primary laparoscopic insertion and seems to be the popular method in adults, particularly in sufferers with prior stomach surgical procedure. Nonetheless, effectively designed randomized managed trials evaluating superior laparoscopic insertion to different strategies are wanted to positively reply the query.

Most well-liked Insertion Approach

Desk 5 gives a abstract of most well-liked insertion method primarily based on affected person components and assumes consultants reminiscent of surgeons and interventional radiologists can be found to carry out the procedures. It’s primarily based on the extent II and III proof of our assessment.

In practices the place surgical entry is proscribed, nephrologist and radiologist inserted catheters utilizing percutaneous or peritoneoscopic strategies could also be your best option primarily based on native gear availability and operator experience.

Desk 5. Most well-liked insertion method in adults:

Historical past of Prior Surgical procedure or peritonitis No historical past of prior surgical procedure or peritonitis
Most well-liked Insertion Approach
(so as of desire)
Most well-liked Insertion Approach
(so as of desire)
Affected person in a position to tolerate Normal anesthesia
  • Superior Laparoscopic
  • Fluoroscopic Guided Percutaneous *
  • Open Surgical
  • Peritoneoscopic
  • Percutaneous
Affected person solely in a position to tolerate native anesthesia /sedation
  • Fluoroscopic Guided Percutaneous
  • Open Surgical
  • Fluoroscopic Guided Percutaneous
  • Open Surgical
  • Peritoneoscopic
  • Percutaneous

* Prime quality proof is missing evaluating FGP to ALS PD catheter insertion in sufferers who’ve by no means had stomach surgical procedure

The above desk gives a abstract of most well-liked insertion method primarily based on affected person components and assumes consultants reminiscent of surgeons and interventional radiologists can be found to carry out the procedures. It’s primarily based on the extent II and III proof of our assessment.

In practices the place surgical entry is proscribed, nephrologist and radiologist inserted catheters utilizing percutaneous or peritoneoscopic strategies could also be your best option primarily based on native gear availability and operator experience.

PEDIATRIC OUTCOMES

Outcomes from massive sequence in pediatric sufferers are introduced in Desk 6.

Desk 6. Outcomes from massive sequence in pediatric sufferers:
Insertion Approach Creator Yr No. Prior surgical procedure? Dysfunction Leak Bleed Perforation
Blind percutaneous Aksu [61] 2007 108 Not acknowledged 24% NR 0 0
Open surgical Stone [166] 1986 167 Not acknowledged 6.1% 14% 0 0
Macchini [167] 2006 89 Not acknowledged 12% 5.6% 0 0
Peritoneoscopic none
Fluro guided percutaneous none
Primary Laparoscopic Stringel [168] 2008 21 23.4% 18% NR 0 0
Superior Laparoscopic * Milliken [89] (o) 2006 22 Not acknowledged 4.5% 4.5% 0 0
Numanoglu [125] (o,s) 2008 36 Not acknowledged 38.8% 5.5% 2.8% 0
Subramaniam [169]  (o) 2008 48 Not acknowledged 10.4% 6.2% 0 0
Superior Laparoscopic  ** none

Dysfunction – outlined as catheter dysfunction requiring elimination, alternative or revisional
* Incorporating lysis of adhesions and both catheter fixation or omentopexy/omentectomy
t = peritoneal tunnel
s = suture fixation
o = omentectomy
**  Incorporating lysis of adhesions, peritoneal tunnel and omentopexy

COMPARATIVE STUDIES IN PEDIATRICS

Within the pediatric literature, there are a number of retrospective research inclusive of sufferers who had open or laparoscopic PD catheter placement, all with the usage of omentectomy in no less than parts of the cohort. None of those opinions famous any important lower in reoperation for catheter dysfunction[68, 133, 135]. One research included 36 sufferers with laparoscopic placement and fixation within the pelvis to 23 sufferers with open catheter placement. Omentectomy was carried out in 85% of the laparoscopic and 65% of the open sufferers. Related charges of peritonitis, exit website infections, and catheter migrations have been famous, although the time to catheter dysfunction was longer for the laparoscopic group (9 vs. 2.4 months)[170]. In a single, potential, non-randomized sequence, catheter leakage occurred in 5 of 23 sufferers present process open placement and solely two of 25 positioned laparoscopically, with one of many two therapeutic spontaneously. The one different complication reported was outflow obstruction, occurring in two sufferers from each the laparoscopic and open teams. The authors concluded laparoscopic catheter insertion is no less than equal, if not superior to open catheter placement when it comes to operate and operative issues[121].

PREFERRED INSERTION TECHNIQUE IN PEDIATRIC PATIENTS

No insertion method has emerged as a transparent desire in pediatric sufferers. A 2004 survey of pediatric surgeons in 2004 revealed that solely 14% of surgeons used laparoscopy for insertion. Nonetheless, growing printed sequence of laparoscopic placement of peritoneal dialysis catheters in pediatric sufferers suggests growing use of this system for insertion.

POSTOPERATIVE COMPLICATIONS

A abstract of postoperative issues is offered in Desk 7.

Desk 7. Early and late postoperative issues
Early issues Late issues
Creator Yr Quantity Bleeding Leak Visceral Damage Exit website An infection Peritonitis Cuff an infection Dysfunction Ache
Crabtree[110] 2009 428 0.0% 2.6% 0.0% NA NA 0.0% 3.7% 0.0%
Keshvari[52] 2009 175 0.6% 7.4% 0.0% NA NA 1.7% 8.4% 0.0%
Lu[124] 2003 148 5.0% 0.0% 0.0% NA 11.0% 18.0% 14.0% NA
Maio[109] 2008 100 0.0% 5.0% 0.0% 0.0% 2.0% 0.0% 6.0% NA
Poole[111] 2000 48 2.0% 2.0% 0.0% 2.0% 8.0% 0.0% 2.0% 0.0%
Schmidt[108] 2007 47 0.0% 12.8% 0.0% 2.1% 10.6% 0.0% 4.3% NA
Ogunc[127] 2005 44 0.0% 0.0% 0.0% 2.1% 0.0% 0.0% 0.0% 0.0%
Ko[106] 2009 38 0.0% 0.0% 0.0% 0.0% 5.3% 0.0% 0.0% 0.0%
Bar-Zohar[107] 2006 34 0.0% 2.9% 0.0% 14.7% na 0.0% 11.7%** 0.0%
Haggerty[95] 2007 33 0.0% 0.0% 0.0% 3.0% 6.5% 0.0% 6.5% 3.2%
  1. Bleeding after PD catheter insertion could happen from inferior epigastric artery harm or lysis of adhesions and ought to be managed in line with normal surgical principals. The insertion level ought to be on the medial border of the rectus sheath to keep away from arterial harm. Coagulation parameters ought to be assessed and corrected pre-operatively. (+Proof, Weak advice)
  2. Dialysate leaks after PD catheter placement could also be amenable to remedy, and doubtlessly prevention, with the usage of fibrin glue, notably within the pediatric inhabitants. (++Proof, Weak advice.)
  3. Exit website an infection is managed by oral antibiotics. Persistent exit website and cuff infections could managed by catheter salvage consisting of unroofing the monitor, shaving the superficial cuff and utilizing a brand new exit website. (++Proof, Weak advice)
  4. Ache throughout PD is a uncommon complication that’s normally amenable to medical administration however sometimes requires repositioning or elimination of the catheter. (++Proof, Weak advice)

Bleeding

Bleeding is a threat after laparoscopic PD catheter insertion occurring in 0 to five% of sufferers in our assessment. The catheter insertion website is thru the rectus sheath and important bleeding could happen from harm to the inferior epigastric artery[111, 124]. If recognized ought to be managed by ligation throughout the process. Bleeding issues may current as postoperative rectus sheath hematoma which can be managed nonoperatively in selective circumstances. Omentectomy and lysis of adhesions may predispose to postoperative intraabdominal bleeding[124]. Lastly, bleeding may happen on the exit website and could also be managed with direct strain or sutures. Bleeding issues related to PD catheter insertion could also be related to anticoagulation. Subsequently coagulation parameters ought to be checked and corrected preoperatively[171]. The usage of dDDAVP has not been studied however could also be useful in a affected person who develops a bleeding complication[171]. Strategies to keep away from arterial harm embody making the insertion website towards the medial border of the rectus sheath and utilizing blunt trocars or sheaths to insert the catheter by means of the stomach wall[113, 115].

Dialysate Leak

Dialysate fluid leak is a recognized drawback occurring in 0 to 12.8% of sufferers after laparoscopic insertion of PD catheter. It might occur early (<30 days) or late (> 30 days). Causes embody Inguinal or stomach wall hernias[35, 172], peritoneal tears[173], leaks across the dialysis catheter , trauma, fluid overload and malignancy[35, 174]. Early leaks generally are from the catheter insertion website or surgical wound and could also be associated to insertion method and / or the timing of the beginning of CAPD after surgical procedure. After open surgical procedure, paramedian insertion has proven to have decrease leak charges in comparison with midline insertion in each adults and youngsters[175, 176]. Low leak charges have additionally been demonstrated after peritoneoscopic insertion[75] and laparoscopic insertion utilizing a protracted peritoneal tunnel[113, 115]. Nonetheless, there is no such thing as a stage I proof to help one method over one other with regard to leak charges.

The remedy of fluid leak is an try at low quantity or cycled PD. If this fails, the leak will normally reply to momentary switch to hemodialysis for 2-4 weeks. If a hernia is detected because the trigger it ought to be repaired utilizing strategies mentioned earlier within the guideline, normally with out disruption of PD[26].

The incidence of dialysate leak has been famous to be increased (as much as 18%) in infants than bigger sufferers, seemingly attributable to their thinner stomach partitions[135]. Rusthoven et. al. reported the usage of fibrin glue to the catheter tunnel exit website in 8 pediatric sufferers in whom dialysate leaks was seen within the first 24-48 hours after catheter insertion. There was no recurrence of leakage and no exit-site, tunnel or peritoneal infections developed[177]. Joffee reported success in sealing power leaks in 5 of 6 grownup sufferers handled with 1 or 2 purposes of fibrin glue, a cohort that will in any other case have had their catheter eliminated[178]. Success in sealing leaks led to at least one randomized, potential trial of fibrin glue software to stop leaks in pediatric sufferers. Sojo et. al. randomized 52 catheter implantations to both normal implantation or software of 1 ml of fibrin sealant to the peritoneal cuff suture[179]. The incidence of catheter leakage was solely 9% within the sealant group, in contrast with 57% within the management group, with no variations within the incidence of infections. Utility of fibrin glue could also be useful in each stopping and sealing dialysate leaks, notably within the pediatric inhabitants.

Visceral Damage

Accidents to the small or massive bowel are hardly ever described after lap PD insertion as a result of direct visualization of the catheter insertion into the stomach. Bowel harm could also be attainable throughout lysis of adhesion however that has not been recognized within the grownup literature.

Exit website and cuff an infection

An infection of the pores and skin on the catheter exit website or hardly ever the pores and skin overlying the insertion website could also be an early or late complication. The preliminary remedy is oral antibiotics. Exit website infections within the pediatric inhabitants are much less seemingly to answer antibiotics alone and surgical salvage could also be wanted. “Cuff shaving” by unroofing the subcutaneous cuff, shaving it off, and rerouting the catheter to an alternate exit website has been reported profitable in 87.5% of kids in a single research from Japan[180]. This method was additionally profitable in 13 adults with power tunnel an infection[181] Wu et. al. described 26 catheters in 23 sufferers through which the complete subcutaneous tubing was changed from simply above the interior cuff with no interruption in dialysis[182]. Salvage of the catheter by these strategies could also be thought-about in choose sufferers who fail antibiotic remedy.

Peritonitis

The incidence of peritonitis after lap PD catheter insertion has been reported between 0-11% which compares to that of open insertion. Its administration consists of intravenous and / or intraperitoneal antibiotics primarily based on tradition outcomes. Catheter elimination is indicated in refractory circumstances and fungal peritonitis.

Ache

Ache on instillation of PD fluid or draining is a recognized complication in sufferers present process PD. It’s regarded as attributable to shearing forces towards the peritoneum or “jet” impact of dialysate rising from the distal finish of the catheter at comparatively excessive velocity. It may also be associated to the pH of the dialysate. If the ache is on outflow, it might be attributable to suction impact and is usually positional. Remedy consists of altering the pH of the fluid, slowing down the infusion, or not fully draining the peritoneum on the finish of dialysis (tidal dialysis)[183]. The ache could resolve with time, sadly whether it is debilitating, catheter repositioning or elimination could also be needed[184, 185].

PD CATHETER MALFUNCTION

Guideline Advice

  1. Malfunctioning peritoneal dialysis catheters ought to be evaluated by bodily examination and plain radiographs to rule out constipation. If destructive, additional research reminiscent of catheterography or CT peritoneography, adopted by diagnostic laparoscopy are indicated. (++ Proof, Weak advice)
  2. Non-operative therapies of malfunctioning PD catheters which have been confirmed efficient embody flushing, thrombolytics and fluoroscopic wire manipulation. (++ Proof, Weak advice)
  3. Sufferers with malfunctioning peritoneal dialysis catheters not amenable to nonoperative measures ought to endure laparoscopy with catheter repositioning, adhesiolysis, omentectomy or omentopexy. Patency ought to be assured by stripping and flushing. Suture fixation of the catheter to the pelvis or polypropylene sling could also be utilized to cut back catheter migration. Surgical strategies for catheter salvage require individualization primarily based upon operative findings. (+++ Proof, Robust advice)

Catheter malfunction has plagued peritoneal dialysis sufferers because the first catheter was positioned in 1968. No insertion method has been in a position to forestall this complication which is irritating to sufferers and medical doctors alike. It causes an interruption in dialysis and requires a number of personnel to be concerned. In actual fact, in a single evaluation, 19.6% of seven,694 sufferers who transferred to hemodialysis from peritoneal dialysis throughout the first 12 months of remedy did so due to mechanical catheter points[113, 186]. Mechanical failure happens in 22-30% of pediatric peritoneal dialysis catheters[133, 135, 187]. Catheter malfunction, outlined as inadequate influx and/or outflow of dialysate, can happen for quite a lot of causes. Catheter influx issues could merely be attributable to catheter kinking exterior to the pores and skin, or from inside catheter obstruction[188]. Early failure from catheter kinking could also be associated to surgical technical error. Influx and outflow failure could also be attributable to intraluminal catheter obstruction attributable to a blood clot or a fibrin plug and this can be precipitated by low grade peritonitis. One of the widespread causes of malfunction is compression of the catheter by distended colon attributable to constipation and this ought to be handled empirically when there’s poor circulate[8, 185]. Bladder distension from urinary retention also can lower outflow. As well as, extraluminal occlusion of the catheter holes by fibrin sheath encapsulation, omental wrapping, peritoneal adhesions, or adjoining organs (small gut, bladder, appendix, fallopian tube, and so on.) will end in outflow failure. Lastly, there will be compartmentalization of the peritoneal cavity by adhesions, or migration of the catheter tip exterior of its dependent location within the pelvis which forestall satisfactory circulate[8, 189-192]. In a registry of pediatric 503 dialysis catheters, failure was attributable to leakage in 5.8%, dislocation in 5.8%, obstruction in 5.3%, and cuff extrusion in 4.8%[187].

Analysis

Comparative research concerning the analysis of malfunctioning PD catheters are missing. Nonetheless, analysis ought to embody bodily examination and radiographic research in an try to elucidate the trigger[192]. Examination of the catheter exterior to the pores and skin ought to rule out kinking or plugging. An algorithmic strategy to the analysis of catheter outflow failures has been described for the analysis of poorly functioning catheters which incorporates inspection of the dialysis fluid look[191]. Cloudy fluid is shipped for leukocyte rely and tradition to evaluate for peritonitis. Obstruction within the presence of clear dialysate warrants analysis with an stomach x-ray to evaluate for catheter tip dislocation or intestinal dilation from constipation. If constipation is deemed to be the trigger, cathartics and enemas are used for remedy[193]. If the catheter tip is dislocated, wire manipulation could also be tried[8]. Within the absence of abnormalities on x-ray, catheterography, or CT peritoneography is the subsequent step. Throughout catheterography, injection of water soluble distinction below fluoroscopy can assess catheter circulate and loculation or compartmentalization of the tip[194, 195]. CT peritoneography may be very helpful in assessing malfunctioning PD Catheters. This check includes CT scanning after instilling a combination of two liters of dialysate and 100 ML of nonionic distinction agent. The affected person is ambulated for 30 to 60 minutes previous to scanning [196]. It has been utilized with success to determine catheter associated issues and obstructions together with peritoneal tear, fluid leak, peritoneal thickening, calcifications, loculated fluid collections, abscesses, hernias, hematomas and catheter malposition[197-200]. Diagnostic laparoscopy can be extremely delicate at diagnosing catheter dysfunction and revision will be employed on the similar time[192].

Nonoperative administration

The administration of catheter malfunction ought to proceed from least to most invasive[192]. Constipation ought to be aggressively managed medically. Intraluminal obstruction attributable to blood clots or fibrin plugs could reply to handbook compression of the dialysis bag or aspiration and forceful flushing with heparinized saline[192]. The usage of fibrinolytic brokers reminiscent of urokinase or TPA adopted by forceful irrigation can be an choice to take away clots and fibrin plugs in each adults and youngsters[201-203]. Two publications report restoration of catheter operate in 57% and 83% respectively[204] [205].

Wire manipulation below fluoroscopy could also be utilized to reposition catheters which have both migrated or have turn out to be wrapped in omentum[206-213]. These strategies contain placement of a stiff-wire into the dialysis catheter below sterile situations. Though most research have utilized these strategies below fluoroscopic steerage, some authors have demonstrated profitable catheter repositioning with out radiographic help[214]. In a retrospective research of 140 sufferers who underwent peritoneal dialysis catheter placement, there have been 49 catheter failures in 33 catheters over the 13 12 months research interval. On this research, catheter migration charges diversified primarily based upon catheter sort with straight catheter migration charges of 54% and swan-neck catheter migration charges of 31%. Amongst these catheter failures that have been handled with fluoroscopic manipulation with a stiff-wire, fast catheter repositioning occurred in 54% though solely 29% of catheters have been efficiently salvaged long-term. No issues occurred on account of these catheter manipulations[215]. One other retrospective research of 203 sufferers demonstrated success charges following fluoroscopic catheter manipulation with a stiff-wire to end in success charges of 78%, 51%, and 25% within the fast, 1 week, and 1 month timeframe following the intervention[210]. The success of fluoroscopic catheter manipulation has been demonstrated to be associated to the orientation of the catheter tunnel at time of insertion. These catheters that have been positioned by means of the stomach wall with an angled tunnel directed towards the pelvis have the best success charges with fluoroscopic manipulation[213]. Profitable catheter salvage has additionally been demonstrated amongst sufferers requiring repeat wire-guided manipulations with secondary salvage charges as excessive as 63%[212]. The utilization of a Fogarty balloon catheter positioned by means of the lumen of the dialysis catheter has additionally been described to facilitate manipulation of the catheter below fluoroscopy[216]. In abstract, wire manipulation has preliminary success charges of 64% to 86% however long term success (>30 days) is considerably decrease (as little as 29%).

Laparoscopy for malfunctioning catheters

In circumstances through which non-operative methods fail to adequately deal with peritoneal dialysis catheter malfunction, or the analysis will not be clear, laparoscopic correction ought to be employed[8, 192, 217]. Quite a few strategies have been described for salvage of malfunctioning peritoneal dialysis catheters, though not all strategies are relevant in every circumstance[131, 217-221]. The particular explanation for the catheter drawback and the findings at laparoscopic exploration dictate the corrective motion. Peritoneal entry could also be gained by way of Veress needle or open Hassan method both in left higher quadrant or periumbilical space. Pneumoperitoneum could also be obtained by insufflating by means of the present PD catheter, thus avoiding any threat from insertion[221]. Nonetheless, this system could also be unsuccessful if omental wrapping or compartmentalization of the catheter is current. The laparoscope could also be launched by means of a periumbilical port to diagnose the etiology of the malfunction. Extra 5 mm working ports are then positioned to control the catheter[131, 189, 191, 219, 222]. Postoperative leakage of dialysate from port websites has been reported, and this has prompted the preferential use of solely 5 mm ports by some authors[220]. As well as, port placement by means of the linea alba has been implicated in postoperative leakage. Consequently, placement of all ports in a location off-midline has been advocated[131]. As well as, the fascia ought to be closed with suture in any respect 10 mm port websites[220].

The commonest findings at laparoscopic exploration are catheter tip migration with or with out related omental adhesions. Though most sequence are small, that is constant throughout a number of stories[189, 219, 222, 223]. In a single sequence of 40 sufferers who underwent laparoscopy for malfunctioning catheters, catheter tip migration was seen in 28, ten of which had related omental adhesions. Two sufferers had catheter migration with adhesed bowel. Omental adhesions within the absence of catheter migration that resulted in a malfunctioning catheter have been seen in 4 of those sufferers[189]. Thus, adhesiolysis and repositioning of the catheter are among the many mostly carried out procedures in catheter revision. Adhesiolysis is mostly carried out by a mixture of blunt and sharp dissection with even handed use of electrocautery. Easy stripping of omentum from the catheter is normally profitable[219]. As soon as free, the catheter is flushed and intently inspected to guarantee patency. If fibrin plugging is current, the catheter could also be stripped with blunt greedy devices. If this doesn’t work, the tip of the catheter will be exteriorized by means of one of many port websites to facilitate clearing[220, 222]. The catheter tip is then changed into a correct dependent place throughout the pelvis. Many authors suggest anchoring the catheter tip throughout the pelvis utilizing a suture. A “polypropylene sling,” through which a suture passer is used to create a loop of nonabsorbable suture across the catheter has additionally been described. The transfascial loop of suture is positioned about 5 cm distal to the insertion website in direction of the pelvis. This maintains the catheter in a caudal path, serving to to stop future migration[131]. Information are inadequate to touch upon the effectiveness of this system in stopping recurrent catheter migration. An alternative choice could also be alternative of the catheter utilizing peritoneal tunneling, however this additionally wants additional research. On the conclusion of any revision process, dialysate is infused and drained to make sure satisfactory influx and outflow, in addition to patency of the catheter[189].

Omental involvement should even be addressed in revision of peritoneal dialysis catheters by both omentectomy, omentopexy or omental folding. Selective use of omentectomy has been advocated by a number of authors[129, 219, 220, 223-226], though omentopexy could also be easier[226, 227]. This may be completed in quite a lot of methods, relying on the desire of the working surgeon. Omental folding described by Goh includes folding the omentum cephalad on itself and suturing it to the gastrocolic omentum, successfully shortening its size[131]. This method was evaluated in a potential research. Amongst 18 sufferers through which omental wrapping was noticed to be the etiology for catheter malfunction, two failures have been noticed. One affected person developed recurrent catheter obstruction 2 weeks after surgical procedure requiring hemodialysis attributable to intensive small bowel adhesions and a second affected person developed recurrent malfunction 5.5 months later which was efficiently salvaged by adhesiolysis at subsequent laparoscopic exploration. Thus, this writer stories successful charge of 89% (16/18) for preliminary laparoscopic salvage with a imply follow-up of 16.5 months[131]. Obstruction could happen from different intra-abdominal constructions together with fallopian tubes, epiploic appendages, vermiform appendix, and small bowel. In a single massive research, the administration of such adhesions included salpingectomy, resection of epiploic appendages, appendectomy, and adhesiolysis[110]. With trendy use of superior strategies, the extra widespread causes for catheter malfunction (i.e. catheter migration, omental adhesions) could turn out to be much less prevalent. Regardless, laparoscopic exploration permits the surgeon to uncover the rationale for catheter malfunction and individualize remedy for every affected person. If laparoscopic revision fails or will not be accessible, catheter alternative is an choice[8]

Peritoneal dialysis could also be resumed shortly following revision of a malfunctioning peritoneal dialysis catheter[228, 229]. Following percutaneous manipulation by means of the catheter, peritoneal dialysis could also be resumed instantly. Following laparoscopic surgical procedure, peritoneal dialysis could also be resumed as early as postoperative day one with the affected person within the supine place. Change volumes are lower than one liter at first and should then be steadily elevated over the next week if the affected person tolerates the rise[228, 230]. There aren’t any comparative trials concerning this topic, nevertheless, Lin recommended a 9 day ready interval to keep away from dialysate leak[231].

Outcomes

There aren’t any trials evaluating lap to open revision of PD catheters. As well as, open revision isn’t described within the literature. Subsequently, proof to help the strategies mentioned above consists primarily of retrospective research. Yilmazlar et al. retrospectively evaluated 37 sufferers who underwent laparoscopic revision, through which catheter repositioning and/or adhesiolysis have been carried out. Catheter patency charges at 30 days and at 12 months have been reported as 97.2% and 62%, respectively. Catheter malfunction recurred in 12 of those sufferers at a imply of 12.4 months, and 5 of them have been efficiently managed with a further laparoscopic salvage process[189]. Amerling, et al. reported a sequence of 26 circumstances of profitable laparoscopic catheter revision; 5 of those circumstances concerned partial omentectomy. 4 sufferers on this sequence developed recurrent malfunction; three of those have been efficiently managed with a further laparoscopic process. These salvaged catheters remained patent for a imply of 9.2 months[219]. A retrospective assessment of 12 sufferers present process catheter revision utilizing selective omentectomy and catheter fixation reported 100% catheter operate at a median of 21 months[223]. In abstract, laparoscopic salvage of malfunctioning PD catheters ends in early success charges of 82% to 100%. Nonetheless, long run > 30 day success is extra variable as two research confirmed failure charges of about 60%. A abstract of laparoscopic salvage articles is introduced in Desk 8.

Desk 8. Abstract of papers on laparoscopic salvage of malfunctioning PD catheters
Reason for obstruction Perform
Creator Yr No. Omentum Adhesions migration plugging different < 30 day > 30 remedy
Kimmelstiel [218] 1993 8 6 2 0 0 0 NR 75% Adhesiolysis, omentectomy, repositioning
Brandt [217] 1996 26 0 19 7 0 0 NR 96% adhesiolysis, repositioning
Amerling [219] 1997 28 0 26 0 0 2 hernias 93% 38% Adhesiolysis,catheter freed
Barone [220] 1998 17 NR NR NR NR NR 82% 42% omentectomy, adhesiolysis
Ogunc [226] 2002 8 3 1 3 1 0 100% NR omentectomy, adhesiolysis, suture fixation, fibrin elimination
Ovant [223] 2002 12 0 4 8 0 0 100% 100% Lysis of adhesions & repositioning
Lee [224] 2002 13 12 0 0 0 1 62% NR Omentectomy & suture fixation
Jonler [232] 2003 14 0 13 0 0 1 NR 93% suture fixation of catheter
Yilmazlar [189] 2006 40 0 10 27 0 3 peritonitis 97.2% 62% 12 months reposition, adhesiolysis, catheter elimination for an infection
Numanoglu [222] 2007 13 1 4 4 0 4Peritonitis NR suture fixation of catheter
Goh [131] 2008 18 18 0 0 0 0 94% 89% omental folding and sling fixation in all circumstances
Zoland [233] 2010 4 2 2 0 0 0 NR 100% adhesiolysis
Zakaria [234] 2011 21 15 0 4 0 2 100% 100% Adhesiolysis, repositioning,Catheter alternative attributable to an infection

Limitations of the accessible literature

The accessible literature on laparoscopic peritoneal dialysis catheter insertion and salvage has a number of limitations. Most research are retrospective in nature and plenty of variations in strategies have been noticed. In trials evaluating insertion strategies, there are small numbers and an elevated threat for bias and different confounding components. As well as, the experience of the operators could differ considerably and for some insertion strategies excessive threat sufferers reminiscent of these with historical past of prior stomach surgical procedure have been excluded. The reporting of final result measures varies additionally as some papers cut up up catheter migration and outflow obstruction as causes for dysfunction. Moreover, protocols differ such because the time interval between surgical procedure and the beginning of PD. This may make a comparability of leak charges inaccurate. Lastly, the follow-up intervals differ vastly, however typically tended to be brief making it troublesome to match knowledge on one method versus one other.

SUMMARY OF GUIDELINE RECOMMENDATIONS

PATIENT SELECTION

  1. Contraindications for laparoscopic PD catheter placement embody lively stomach an infection and uncorrectable mechanical defects of the stomach wall (+++ Proof, Robust advice)
  2. Historical past of prior stomach surgical procedure, no matter what number of, will not be a contraindication to laparoscopic PD catheter insertion. It’s applicable for surgeons with expertise in superior laparoscopy to aim lysis of adhesions and catheter placement in these sufferers. (++Proof, Robust advice,)
  3. Sufferers with stomach wall hernias ought to be identified and repaired earlier than or concurrently PD catheter insertion. A restore ought to be chosen that minimizes peritoneal dissection and doesn’t place mesh intraperitoneally (++ Proof, Weak advice)
  4. Peritoneal dialysis could also be initiated in sufferers with intraabdominal overseas our bodies reminiscent of after open stomach aortic aneurysm graft restore, however a 4 month ready interval is advisable. Very restricted knowledge exists concerning peritoneal dialysis within the presence of an adjustable gastric band. (++ Proof, Weak advice)
  5. Peritoneal dialysis could also be safely initiated in sufferers with ventriculoperitoneal shunts (++ Proof, Weak advice)
  6. Gastrostomy tubes can be utilized in pediatric sufferers on peritoneal dialysis, although placement by blind percutaneous endoscopic method (PEG) seems to be related to increased an infection charges in comparison with open insertion. (++ Proof, Weak advice)
  7. Laparoscopic PD catheter insertion with carbon dioxide pneumoperitoneum requires common anesthesia. Sufferers who’re excessive threat to endure common anesthesia ought to be thought-about for a method of catheter insertion that solely requires native anesthesia and sedation, reminiscent of open insertion or fluoroscopically guided percutaneous insertion. Laparoscopic insertion utilizing nitrous oxide pneumoperitoneum and native anesthesia can be an choice the place accessible. (++ Proof, Weak advice)

INSERTION OPTIONS

  1. For peritoneal entry, blind percutaneous, open surgical, peritoneoscopic, fluoroscopically guided percutaneous, and laparoscopic insertion procedures, when carried out by skilled operators, are possible and secure with acceptable outcomes. (++++, Robust advice)

ADVANCED LAPAROSCOIC TECHNIQUES TO AVOID CATHETER DYSFUNCTION

  1. Laparoscopic lysis of adhesions ought to be included to cut back catheter dysfunction. (+++ Proof, Robust advice)
  2. Laparoscopic suture fixation of the PD catheter could scale back catheter dysfunction however extra proof is required. (++ Proof, Weak advice)
  3. Rectus sheath tunneling helps forestall migration and could also be superior to suture fixation because it doesn’t require added ports and devices. (++ Proof, Weak advice)
  4. Omentopexy in adults is a secure adjunct to laparoscopic PD catheter insertion and ought to be included both routinely or selectively to cut back catheter dysfunction. (+++ Proof, Weak advice)
  5. Omentectomy ought to be thought-about in pediatric sufferers present process peritoneal dialysis catheter placement (++ Proof, Weak advice)
  6. The mixture of lysis of adhesions, rectus sheath tunneling and omentopexy together presents the bottom charge of postoperative PD catheter dysfunction and ought to be a most well-liked method in adults. (+++ Proof, Robust advice)

PERIOPERATIVE CONSIDERATIONS

  1. Presurgical evaluation ought to embody thorough examination for hernias and the catheter exit website ought to be marked earlier than surgical procedure. (+ Proof, Weak advice)
  2. A necessity for preoperative bowel preparation has not been conclusively demonstrated and additional proof is required earlier than a advice will be offered
  3. Prophylactic antibiotics ought to be used previous to laparoscopic insertion of PD catheter. Vancomycin could also be superior to first era cephalosporins in minimizing early peritonitis after PD insertion however native resistance patterns ought to be additionally thought-about when selecting the preoperative antibiotic ( +++ Proof, Robust advice)

SURGICAL TECHNIQUE

  1. Peritoneal entry throughout lap PD insertion ought to be obtained away from earlier scars; surgeons ought to use the method they’re most comfy and skilled with. ( ++ Proof, Weak advice)
  2. The surgeon ought to decrease the dimensions and variety of ports used and place them in a fashion that optimizes visualization of the catheter peritoneal insertion level and the pelvis. (++ Proof, Weak advice)
  3. When inserting the PD catheter by means of the stomach wall, the deep cuff ought to be positioned contained in the rectus sheath. (++ Proof, Robust advice).
  4. The superficial PD catheter cuff ought to be 2 cm from the pores and skin exit website in kids and no less than 2 cm in adults to stop future cuff extrusion. (+Proof, Weak advice) (++Proof, Weak advice)

POSTOPERATIVE PROTOCOL

  1. Minimizing dressing adjustments and dealing with could also be helpful within the first two postop weeks. (+ Proof, Weak advice)
  2. Satisfactory time ought to be given after surgical procedure for therapeutic earlier than PD is initiated and the present normal is 2 weeks. A extra pressing begin ought to be thought-about when the advantages outweigh the dangers (++ Proof, Weak advice)

OUTCOMES BY SURGICAL PROCEDURE

  1. Blind percutaneous PD catheter insertion has acceptable malfunction and leak charges in contrast with open insertion in sufferers who’ve by no means had prior stomach surgical procedure. The method could also be particularly helpful in high-risk sufferers for common anesthesia as it may be carried out on the bedside, below native anesthesia by educated nephrologists. Nonetheless, bowel perforation and bleeding threat ought to be thought-about (+++ Proof, Weak advice)
  2. Open surgical insertion continues to be a normal to which others are in contrast. It’s secure (low perforation charge) and efficient and will be carried out below native anesthesia and sedation. It seems to have increased leak and dysfunction charges in comparison with picture guided percutaneous and superior laparoscopic insertion. (+++ Proof, Weak advice)
  3. Peritoneoscopic insertion is a method used worldwide, largely by “interventional” nephrologists. It has been studied in sufferers who’ve had prior surgical procedure, however there’s no less than a 1% perforation charge. It seems to be corresponding to open surgical insertion in skilled arms, however has not been in comparison with laparoscopic and fluoroscopic guided percutaneous insertion. (++ Proof, Weak advice)
  4. In sufferers with out prior stomach surgical procedure, percutaneous fluoroscopic PD catheter insertion ends in comparable or higher complication charges and dysfunction charges in comparison with open or primary laparoscopic insertion, and avoids common anesthesia. (+++ Proof, Weak advice)
  5. Primary laparoscopic insertion with out utilizing strategies to attenuate catheter dysfunction ends in comparable dysfunction charges as open insertion. (+++ Proof, Robust advice)
  6. Superior laparoscopic PD catheter insertion utilizing lysis of adhesions, catheter fixation ideally with rectus sheath tunnel, and omentopexy carried out together has the bottom reported charge of catheter dysfunction in adults, even in sufferers with prior stomach surgical procedure. (+++ Proof, Robust advice)

EARLY POSTOP COMPLICATIONS

  1. Bleeding after PD catheter insertion could happen from inferior epigastric artery harm or lysis of adhesions and ought to be managed in line with normal surgical principals. The insertion level ought to be on the medial border of the rectus sheath to keep away from arterial harm. Coagulation parameters ought to be assessed and corrected pre-operatively. (+Proof, Weak advice)
  2. Dialysate leaks after PD catheter placement could also be amenable to remedy, and doubtlessly prevention, with the usage of fibrin glue, notably within the pediatric inhabitants. (++Proof, Weak advice.)
  3. Exit website an infection is managed by oral antibiotics. Persistent exit website and cuff infections could managed by catheter salvage consisting of unroofing the monitor, shaving the superficial cuff and utilizing a brand new exit website. (++Proof, Weak advice)
  4. Ache throughout PD is a uncommon complication that’s normally amenable to medical administration however sometimes requires repositioning or elimination of the catheter. (++Proof, Weak advice)

PD CATHETER MALFUNCTION

  1. Malfunctioning peritoneal dialysis catheters ought to be evaluated by bodily examination and plain radiographs to rule out constipation. If destructive, additional research reminiscent of catheterography or CT peritoneography, adopted by diagnostic laparoscopy are indicated. (++ Proof, Weak advice)
  2. Non-operative therapies of malfunctioning PD catheters which have been confirmed efficient embody flushing, thrombolytics and fluoroscopic wire manipulation. (++ Proof, Weak advice)
  3. Sufferers with malfunctioning peritoneal dialysis catheters not amenable to nonoperative measures ought to endure laparoscopy with catheter repositioning, adhesiolysis, omentectomy or omentopexy. Patency ought to be assured by stripping and flushing. Suture fixation of the catheter to the pelvis or polypropylene sling could also be utilized to cut back catheter migration. Surgical strategies for catheter salvage require individualization primarily based upon operative findings. (+++ Proof, Robust advice)

Monetary Disclosures

Not one of the authors have company/industrial relationships which may pose a battle of curiosity to this paper. Dr. Haggerty has labored as a guide for Bard. Dr. Roth is a grant recipient from Allergan and Miramatrix, a guide for WL Gore and a grant recipient and guide for Bard, LifeCell and MTF. His can be a guide for and fairness holder of New Wave Surgical. Dr. Stefanidis has acquired honorarium from Bard and WL Gore. Dr. Fanelli is an proprietor and director of New Wave Surgical Company, shareholder of EndoGastric Options, and guide for Prepare dinner Surgical, Inc. Drs. Walsh, Value, Penner, and Richardson don’t have anything to reveal.

Bibliography

  1. High-quality J, Frank HA, Seligman AM (1946) The remedy of acute renal failure by peritoneal irrigation. Ann Surg 124:857-878
  2. Grollman A, Turner LB, Mc LJ (1951) Intermittent peritoneal lavage in nephrectomized canine and its software to the human being. AMA Arch Intern Med 87:379-390
  3. Maxwell MH, Rockney RE, Kleeman CR, Twiss MR (1959) Peritoneal dialysis. 1. Approach and purposes. J Am Med Assoc 170:917-924
  4. Oreopoulos DG, Robson M, Izatt S, Clayton S, deVeber GA (1978) A easy and secure method for steady ambulatory peritoneal dialysis (CAPD). Trans Am Soc Artif Intern Organs 24:484-489
  5. Nolph KD, Sorkin M, Rubin J, Arfania D, Prowant B, Fruto L, Kennedy D (1980) Steady ambulatory peritoneal dialysis: three-year expertise at one middle. Ann Intern Med 92:609-613
  6. Mehrotra R, Kermah D, Fried L, Kalantar-Zadeh Okay, Khawar O, Norris Okay, Nissenson A (2007) Persistent peritoneal dialysis in america: declining utilization regardless of enhancing outcomes. J Am Soc Nephrol 18:2781-2788
  7. Neu AM, Ho PL, McDonald RA, Warady BA (2002) Persistent dialysis in kids and adolescents. The 2001 NAPRTCS Annual Report. Pediatr Nephrol 17:656-663
  8. Shahbazi N, McCormick BB (2011) Peritoneal dialysis catheter insertion methods and upkeep of catheter operate. Semin Nephrol 31:138-151
  9. (2012) U.S. Renal Information System, USRDS 2012 Annual Information Report: Atlas of Finish-Stage Renal Illness in america, Nationwide Institutes of Well being, Nationwide Institute of Diabetes and Digestive and Kidney Ailments, Bethesda, MD.224
  10. Juergensen E, Wuerth D, Finkelstein SH, Juergensen PH, Bekui A, Finkelstein FO (2006) Hemodialysis and peritoneal dialysis: sufferers’ evaluation of their satisfaction with remedy and the affect of the remedy on their lives. Clin J Am Soc Nephrol 1:1191-1196
  11. Rubin HR, Fink NE, Plantinga LC, Sadler JH, Kliger AS, Powe NR (2004) Affected person rankings of dialysis care with peritoneal dialysis vs hemodialysis. JAMA 291:697-703
  12. Barendse SM, Speight J, Bradley C (2005) The Renal Remedy Satisfaction Questionnaire (RTSQ): a measure of satisfaction with remedy for power kidney failure. Am J Kidney Dis 45:572-579
  13. Tokgoz B (2009) Scientific benefits of peritoneal dialysis. Perit Dial Int 29 Suppl 2:S59-61
  14. Shetty A OG (2000) Peritoneal dialysis: Its indications and contraindications. Dialysis & Transplantation 29:71-77
  15. Basis NK (2001) Okay/DPQI Scientific Apply Pointers for Peritoneal dialysis Adequacy: Replace 2000. Am J Kidney Dis 37:S65-136
  16. Basis NK (2006) KDOQI Scientific Apply Pointers and Scientific Apply Suggestions for 2006 updates: hemodialysis adequacy, peritoneal dialysis adequacy and vascular entry. Am J Kidney Dis 48:S1-S322
  17. Fischbach M, Stefanidis CJ, Watson AR (2002) Pointers by an advert hoc European committee on adequacy of the paediatric peritoneal dialysis prescription. Nephrol Dial Transplant 17:380-385
  18. Menzies D, Ellis H (1990) Intestinal obstruction from adhesions–how huge is the issue? Ann R Coll Surg Engl 72:60-63
  19. Crabtree JH, Burchette RJ (2009) Impact of prior stomach surgical procedure, peritonitis, and adhesions on catheter operate and long-term final result on peritoneal dialysis. Am Surg 75:140-147
  20. Keshvari A, Fazeli MS, Meysamie A, Seifi S, Taromloo MK (2008) The consequences of earlier stomach operations and intraperitoneal adhesions on the result of peritoneal dialysis catheters. Perit Dial Int 30:41-45
  21. Murala JS, Singappuli Okay, Provenzano SC, Jr., Nunn G Strategies of inserting peritoneal dialysis catheters in neonates and infants present process open coronary heart surgical procedure. J Thorac Cardiovasc Surg 139:503-505
  22. Yildiz N, Memisoglu A, Benzer M, Altuntas U, Alpay H (2013) Can peritoneal dialysis be utilized in preterm infants with congenital diaphragmatic hernia? J Matern Fetal Neonatal Med 26:943-945
  23. Del Peso G, Bajo MA, Costero O, Hevia C, Gil F, Diaz C, Aguilera A, Selgas R (2003) Danger components for stomach wall issues in peritoneal dialysis sufferers. Perit Dial Int 23:249-254
  24. von Lilien T, Salusky IB, Yap HK, Fonkalsrud EW, High-quality RN (1987) Hernias: a frequent complication in kids handled with steady peritoneal dialysis. Am J Kidney Dis 10:356-360
  25. Pauls DG, Basinger BB, Protect CF, third (1992) Inguinal herniorrhaphy within the steady ambulatory peritoneal dialysis affected person. Am J Kidney Dis 20:497-499
  26. Lewis DM, Bingham C, Beaman M, Nicholls AJ, Riad HN (1998) Polypropylene mesh hernia restore–an alternate allowing fast return to peritoneal dialysis. Nephrol Dial Transplant 13:2488-2489
  27. Morris-Stiff GJ, Bowrey DJ, Jurewicz WA, Lord RH (1998) Administration of inguinal herniae in sufferers on steady ambulatory peritoneal dialysis: an audit of present UK observe. Postgrad Med J 74:669-670
  28. Wakasugi M, Hirata T, Okamura Y, Minamimura Okay, Umemura A, Kikuichi M, Sakamoto M (2011) Perioperative administration of steady ambulatory peritoneal dialysis sufferers present process inguinal hernia surgical procedure. Surg Right now 41:297-299
  29. Gianetta E, Civalleri D, Serventi A, Floris F, Mariani F, Aloisi F, Saffioti S (2004) Anterior tension-free restore below native anesthesia of stomach wall hernias in steady ambulatory peritoneal dialysis sufferers. Hernia 8:354-357
  30. Garcia-Urena MA, Rodriguez CR, Vega Ruiz V, Carnero Hernandez FJ, Fernandez-Ruiz E, Vazquez Gallego JM, Velasco Garcia M (2006) Prevalence and administration of hernias in peritoneal dialysis sufferers. Perit Dial Int 26:198-202
  31. Crabtree JH (2006) Hernia restore at once in initiating or persevering with peritoneal dialysis. Perit Dial Int 26:178-182
  32. Shah H, Chu M, Bargman JM (2006) Perioperative administration of peritoneal dialysis sufferers present process hernia surgical procedure with out the usage of interim hemodialysis. Perit Dial Int 26:684-687
  33. Nicholson ML, Madden AM, Veitch PS, Donnelly PK (1989) Mixed stomach hernia restore and steady ambulatory peritoneal dialysis (CAPD) catheter insertion. Perit Dial Int 9:307-308
  34. Leblanc M, Ouimet D, Pichette V (2001) Dialysate leaks in peritoneal dialysis. Semin Dial 14:50-54
  35. Tzamaloukas AH, Gibel LJ, Eisenberg B, Goldman RS, Kanig SP, Zager PG, Elledge L, Wooden B, Simon D (1990) Early and late peritoneal dialysate leaks in sufferers on CAPD. Adv Perit Dial 6:64-71
  36. Crabtree JH, Fishman A (2003) Laparoscopic implantation of swan neck presternal peritoneal dialysis catheters. J Laparoendosc Adv Surg Tech A 13:131-137
  37. Twardowski ZJ (2002) Presternal peritoneal catheter. Adv Ren Exchange Ther 9:125-132
  38. Gulanikar AC, Jindal KK, Hirsch DJ (1991) Is power peritoneal dialysis secure in sufferers with intra-abdominal prosthetic vascular grafts? Nephrol Dial Transplant 6:215-217
  39. Schmidt RJ, Cruz C, Dumler F (1993) Efficient steady ambulatory peritoneal dialysis following stomach aortic aneurysm restore. Perit Dial Int 13:40-44
  40. Maccario M, De Vecchi A, Scalamogna A, Castelnovo C, Ponticelli C (1997) Steady ambulatory peritoneal dialysis in sufferers after intra-abdominal prosthetic vascular graft surgical procedure. Nephron 77:159-163
  41. Charytan C (1992) Steady ambulatory peritoneal dialysis after stomach aortic graft surgical procedure. Perit Dial Int 12:227-229
  42. Misra M, Goel S, Khanna R (1998) Peritoneal dialysis in sufferers with stomach vascular prostheses. Adv Perit Dial 14:95-97
  43. Valle GA, Kissane BE, de la Cruz-Munoz N (2012) Profitable laparoscopic bariatric surgical procedure in peritoneal dialysis sufferers with out interruption of their CKD6 remedy modality. Adv Perit Dial 28:134-139
  44. Dolan NM, Borzych-Duzalka D, Suarez A, Principi I, Hernandez O, Al-Akash S, Alconchar L, Breen C, Fischbach M, Flynn J, Pape L, Piantanida JJ, Printza N, Wong W, Zaritsky J, Schaefer F, Warady BA, White CT Ventriculoperitoneal shunts in kids on peritoneal dialysis: a survey of the Worldwide Pediatric Peritoneal Dialysis Community. Pediatr Nephrol 28:315-319
  45. Korzets Z, Golan E, Naftali T, Bernheim J (1992) Peritoneal dialysis within the presence of a stoma. Perit Dial Int 12:258-260
  46. Warchol S, Roszkowska-Blaim M, Latoszynska J, Jarmolinski T, Zachwieja J (2003) Expertise utilizing presternal catheter for peritoneal dialysis in Poland: a multicenter pediatric survey. Perit Dial Int 23:242-248
  47. Chadha V, Jones LL, Ramirez ZD, Warady BA (2000) Chest wall peritoneal dialysis catheter placement in infants with a colostomy. Adv Perit Dial 16:318-320
  48. Rahim KA, Seidel Okay, McDonald RA (2004) Danger components for catheter-related issues in pediatric peritoneal dialysis. Pediatr Nephrol 19:1021-1028
  49. von Schnakenburg C, Feneberg R, Plank C, Zimmering M, Arbeiter Okay, Bald M, Fehrenbach H, Griebel M, Licht C, Konrad M, Timmermann Okay, Kemper MJ (2006) Percutaneous endoscopic gastrostomy in kids on peritoneal dialysis. Perit Dial Int 26:69-77
  50. Ledermann SE, Spitz L, Moloney J, Rees L, Trompeter RS (2002) Gastrostomy feeding in infants and youngsters on peritoneal dialysis. Pediatr Nephrol 17:246-250
  51. Lindley RM, Williams AR, Fraser N, Shenoy MU (2012) Synchronous laparoscopic-assisted percutaneous endoscopic gastrostomy and peritoneal dialysis catheter placement is a legitimate various to open surgical procedure. J Pediatr Urol
  52. Keshvari A, Najafi I, Jafari-Javid M, Yunesian M, Chaman R, Taromlou MN (2009) Laparoscopic peritoneal dialysis catheter implantation utilizing a Tenckhoff trocar below native anesthesia with nitrous oxide fuel insufflation. Am J Surg 197:8-13
  53. Crabtree JH, Fishman A, Huen IT (1998) Videolaparoscopic peritoneal dialysis catheter implant and rescue procedures below native anesthesia with nitrous oxide pneumoperitoneum. Adv Perit Dial 14:83-86
  54. Kahn MR, Robbins MJ, Kim MC, Fuster V Administration of heart problems in sufferers with kidney illness. Nat Rev Cardiol
  55. Tenckhoff H, Schechter H (1968) A bacteriologically secure peritoneal entry gadget. Trans Am Soc Artif Intern Organs 14:181-187
  56. Zappacosta AR, Perras ST, Closkey GM (1991) Seldinger method for Tenckhoff catheter placement. ASAIO Trans 37:13-15
  57. Napoli M, Russo F, Mastrangelo F (2000) Placement of peritoneal dialysis catheter by percutaneous methodology with the Veress needle. Adv Perit Dial 16:165-169
  58. Banli O, Altun H, Oztemel A (2005) Early begin of CAPD with the Seldinger method. Perit Dial Int 25:556-559
  59. Allon M, Soucie JM, Macon EJ (1988) Problems with everlasting peritoneal dialysis catheters: expertise with 154 percutaneously positioned catheters. Nephron 48:8-11
  60. Mellotte GJ, Ho CA, Morgan SH, Bending MR, Eisinger AJ (1993) Peritoneal dialysis catheters: a comparability between percutaneous and traditional surgical placement strategies. Nephrol Dial Transplant 8:626-630
  61. Aksu N, Yavascan O, Anil M, Kara OD, Erdogan H, Bal A (2007) A ten-year single-centre expertise in kids on power peritoneal dialysis–significance of percutaneous placement of peritoneal dialysis catheters. Nephrol Dial Transplant 22:2045-2051
  62. Varughese S, Sundaram M, Basu G, Tamilarasi V, John GT Percutaneous steady ambulatory peritoneal dialysis (CAPD) catheter insertion–a most well-liked choice for growing nations. Trop Doct 40:104-105
  63. Brewer TE, Caldwell FT, Patterson RM, Flanigan WJ (1972) Indwelling peritoneal (Tenckhoff) dialysis catheter. Expertise with 24 sufferers. JAMA 219:1011-1015
  64. Nicholson ML, Donnelly PK, Burton PR, Veitch PS, Partitions J (1990) Elements influencing peritoneal catheter survival in steady ambulatory peritoneal dialysis. Ann R Coll Surg Engl 72:368-372
  65. Stegmayr BG (1994) Lateral catheter insertion along with three purse-string sutures reduces the danger for leakage throughout peritoneal dialysis. Artif Organs 18:309-313
  66. Washburn KK, Currier H, Salter KJ, Brandt ML (2004) Surgical method for peritoneal dialysis catheter placement within the pediatric affected person: a North American survey. Adv Perit Dial 20:218-221
  67. Brandt ML, Brewer ED (2008) Peritoneal Catheter Placement in Youngsters. In: Nissenson A, High-quality RN (eds) Handbook of Dialysis Remedy, Saunders (Elsevier Inc.), pp 1295-1301
  68. Mattioli G, Castagnetti M, Verrina E, Trivelli A, Torre M, Jasonni V, Perfumo F (2007) Laparoscopic-assisted peritoneal dialysis catheter implantation in pediatric sufferers. Urology 69:1185-1189
  69. Figueiredo A, Goh BL, Jenkins S, Johnson DW, Mactier R, Ramalakshmi S, Shrestha B, Struijk D, Wilkie M (2010) Scientific observe pointers for peritoneal entry. Perit Dial Int 30:424-429
  70. Rubin J, Adair CM, Raju S, Bower JD (1982) The Tenckhoff catheter for peritoneal dialysis–an appraisal. Nephron 32:370-374
  71. Cronen PW, Moss JP, Simpson T, Rao M, Cowles L (1985) Tenckhoff catheter placement: surgical features. Am Surg 51:627-629
  72. Bullmaster JR, Miller SF, Finley RK, Jr., Jones LM (1985) Surgical features of the Tenckhoff peritoneal dialysis catheter. A 7 12 months expertise. Am J Surg 149:339-342
  73. Olcott Ct, Feldman CA, Coplon NS, Oppenheimer ML, Mehigan JT (1983) Steady ambulatory peritoneal dialysis. Strategy of catheter insertion and administration of related surgical issues. Am J Surg 146:98-102
  74. Swartz RD (1985) Persistent peritoneal dialysis: mechanical and infectious issues. Nephron 40:29-37
  75. Ash SR (1981) Placement of the Tenckhoff peritoneal dialysis catheter below peritoneoscopic visualization. Dialysis & Transplantation 10:82-86
  76. Maffei S, Bonello F, Stramignoni E, Forneris G, Iadarola GM, Borca M, Quarello F (1992) [Two years of experience and 119 peritoneal dialysis catheters placed with peritoneoscopy control and Y-TEC system]. Minerva Urol Nefrol 44:63-67
  77. Nahman NS, Jr., Middendorf DF, Bay WH, McElligott R, Powell S, Anderson J (1992) Modification of the percutaneous strategy to peritoneal dialysis catheter placement below peritoneoscopic visualization: scientific ends in 78 sufferers. J Am Soc Nephrol 3:103-107
  78. Eklund B, Groop PH, Halme L, Honkanen E, Kala AR (1998) Peritoneal dialysis entry: a comparability of peritoneoscopic and surgical insertion strategies. Scand J Urol Nephrol 32:405-408
  79. Kelly J, McNamara Okay, Could S (2003) Peritoneoscopic peritoneal dialysis catheter insertion. Nephrology (Carlton) 8:315-317
  80. Goh BL, Ganeshadeva YM, Chew SE, Dalimi MS (2008) Does peritoneal dialysis catheter insertion by interventional nephrologists improve peritoneal dialysis penetration? Semin Dial 21:561-566
  81. Li PK, Chow KM (2009) Significance of peritoneal dialysis catheter insertion by nephrologists: observe makes excellent. Nephrol Dial Transplant 24:3274-3276
  82. Asif A, Byers P, Vieira CF, Merrill D, Gadalean F, Bourgoignie JJ, Leclercq B, Roth D, Gadallah MF (2003) Peritoneoscopic placement of peritoneal dialysis catheter and bowel perforation: expertise of an interventional nephrology program. Am J Kidney Dis 42:1270-1274
  83. Maya ID (2007) Ultrasound/fluoroscopy-assisted placement of peritoneal dialysis catheters. Semin Dial 20:611-615
  84. Vaux EC, Torrie PH, Barker LC, Naik RB, Gibson MR (2008) Percutaneous fluoroscopically guided placement of peritoneal dialysis catheters–a 10-year expertise. Semin Dial 21:459-465
  85. Savader SJ, Geschwind JF, Lund GB, Scheel PJ (2000) Percutaneous radiologic placement of peritoneal dialysis catheters: long-term outcomes. J Vasc Interv Radiol 11:965-970
  86. Moon JY, Track S, Jung KH, Park M, Lee SH, Ihm CG, Oh JH, Kwon SH, Lee TW (2008) Fluoroscopically guided peritoneal dialysis catheter placement: long-term outcomes from a single middle. Perit Dial Int 28:163-169
  87. Reddy C, Dybbro PE, Visitor S Fluoroscopically guided percutaneous peritoneal dialysis catheter placement: single middle expertise and assessment of the literature. Ren Fail 32:294-299
  88. Crabtree JH (2009) The usage of the laparoscope for dialysis catheter implantation: invaluable carry-on or extra baggage? Perit Dial Int 29:394-406
  89. Milliken I, Fitzpatrick M, Subramaniam R (2006) Single-port laparoscopic insertion of peritoneal dialysis catheters in kids. J Pediatr Urol 2:308-311
  90. Kurihara S, Akiba T, Takeuchi M, Nakajima Okay, Inoue H, Yoneshima H (1995) Laparoscopic mesenterioadhesiotomy and Tenckhoff catheter placement in sufferers with predisposing stomach surgical procedure. Artif Organs 19:1248-1250
  91. Harissis HV, Katsios CS, Koliousi EL, Ikonomou MG, Siamopoulos KC, Fatouros M, Kappas AM (2006) A brand new simplified one port laparoscopic strategy of peritoneal dialysis catheter placement with intra-abdominal fixation. Am J Surg 192:125-129
  92. Wang JY, Hsieh JS, Chen FM, Chuan CH, Chan HM, Huang TJ (1999) Safe placement of steady ambulatory peritoneal dialysis catheters below laparoscopic help. Am Surg 65:247-249
  93. Watson DI, Paterson D, Bannister Okay (1996) Safe placement of peritoneal dialysis catheters utilizing a laparoscopic method. Surg Laparosc Endosc 6:35-37
  94. Ogunc G (2001) Videolaparoscopy with omentopexy: a brand new method to permit placement of a catheter for steady ambulatory peritoneal dialysis. Surg Right now 31:942-944
  95. Haggerty SP, Zeni TM, Carder M, Frantzides CT (2007) Laparoscopic peritoneal dialysis catheter insertion utilizing a Quinton percutaneous insertion package. JSLS 11:208-214
  96. Comert M, Borazan A, Kulah E, Ucan BH (2005) A brand new laparoscopic method for the position of a everlasting peritoneal dialysis catheter: the preperitoneal tunneling methodology. Surg Endosc 19:245-248
  97. Barone GW, Lightfoot ML, Ketel BL (2002) Approach for laparoscopy-assisted difficult peritoneal dialysis catheter placement. J Laparoendosc Adv Surg Tech A 12:53-55
  98. Al-Dohayan A (1999) Laparoscopic placement of peritoneal dialysis catheter (similar day dialysis). JSLS 3:327-329
  99. Al-Hashemy AM, Seleem MI, Al-Ahmary AM, Bin-Mahfooz AA (2004) A two-port laparoscopic placement of peritoneal dialysis catheter: a preliminary report. Saudi J Kidney Dis Transpl 15:144-148
  100. Brownlee J, Elkhairi S (1997) Laparoscopic assisted placement of peritoneal dialysis catheter: a preliminary expertise. Clin Nephrol 47:122-124
  101. Caliskan Okay, Nursal TZ, Tarim AM, Noyan T, Moray G, Haberal M (2007) The adequacy of laparoscopy for steady ambulatory peritoneal dialysis procedures. Transplant Proc 39:1359-1361
  102. Leung LC, Yiu MK, Man CW, Chan WH, Lee KW, Lau KW (1998) Laparoscopic administration of Tenchkoff catheters in steady ambulatory peritoneal dialysis. A one-port method. Surg Endosc 12:891-893
  103. Manouras AJ, Kekis PB, Stamou KM, Konstadoulakis MM, Apostolidis NS (2004) Laparoscopic placement of Oreopoulos-Zellerman catheters in CAPD sufferers. Perit Dial Int 24:252-255
  104. Nijhuis PH, Smulders JF, Jakimowicz JJ (1996) Laparoscopic introduction of a steady ambulatory peritoneal dialysis (capd) catheter by a two-puncture method. Surg Endosc 10:676-679
  105. Yan X, Zhu W, Jiang CM, Huang HF, Zhang M, Guo HQ Scientific software of one-port laparoscopic placement of peritoneal dialysis catheters. Scand J Urol Nephrol 44:341-344
  106. Ko J, Ra W, Bae T, Lee T, Kim HH, Han HS (2009) Two-port laparoscopic placement of a peritoneal dialysis catheter with stomach wall fixation. Surg Right now 39:356-358
  107. Bar-Zohar D, Sagie B, Lubezky N, Blum M, Klausner J, Abu-Abeid S (2006) Laparoscopic implantation of the Tenckhoff catheter for the remedy of end-stage renal failure and congestive coronary heart failure: expertise with the pelvic fixation method. Isr Med Assoc J 8:174-178
  108. Schmidt SC, Pohle C, Langrehr JM, Schumacher G, Jacob D, Neuhaus P (2007) Laparoscopic-assisted placement of peritoneal dialysis catheters: implantation method and outcomes. J Laparoendosc Adv Surg Tech A 17:596-599
  109. Maio R, Figueiredo N, Costa P (2008) Laparoscopic placement of Tenckhoff catheters for peritoneal dialysis: a secure, efficient, and reproducible process. Perit Dial Int 28:170-173
  110. Crabtree JH, Burchette RJ (2009) Efficient use of laparoscopy for long-term peritoneal dialysis entry. Am J Surg 198:135-141
  111. Poole GH, Tervit P (2000) Laparoscopic Tenckhoff catheter insertion: a potential research of a brand new method. Aust N Z J Surg 70:371-373
  112. Soontrapornchai P, Simapatanapong T (2005) Comparability of open and laparoscopic safe placement of peritoneal dialysis catheters. Surg Endosc 19:137-139
  113. Attaluri V, Lebeis C, Brethauer S, Rosenblatt S (2010) Superior laparoscopic strategies considerably enhance operate of peritoneal dialysis catheters. J Am Coll Surg 211:699-704
  114. Ogunc G, Tuncer M, Ogunc D, Yardimsever M, Ersoy F (2003) Laparoscopic omental fixation method versus open surgical placement of peritoneal dialysis catheters. Surg Endosc 17:1749-1755
  115. Crabtree JH, Fishman A (2005) A laparoscopic methodology for optimum peritoneal dialysis entry. Am Surg 71:135-143
  116. Wright MJ, Bel’eed Okay, Johnson BF, Eadington DW, Sellars L, Farr MJ (1999) Randomized potential comparability of laparoscopic and open peritoneal dialysis catheter insertion. Perit Dial Int 19:372-375
  117. Draganic B, James A, Sales space M, Gani JS (1998) Comparative expertise of a easy method for laparoscopic power ambulatory peritoneal dialysis catheter placement. Aust N Z J Surg 68:735-739
  118. Blessing WD, Jr., Ross JM, Kennedy CI, Richardson WS (2005) Laparoscopic-assisted peritoneal dialysis catheter placement, an enchancment on the only trocar method. Am Surg 71:1042-1046
  119. Jwo SC, Chen KS, Lee CC, Chen HY (2010) Potential randomized research for comparability of open surgical procedure with laparoscopic-assisted placement of Tenckhoff peritoneal dialysis catheter–a single middle expertise and literature assessment. J Surg Res 159:489-496
  120. Gajjar AH, Rhoden DH, Kathuria P, Kaul R, Udupa AD, Jennings WC (2007) Peritoneal dialysis catheters: laparoscopic versus conventional placement strategies and outcomes. Am J Surg 194:872-875; dialogue 875-876
  121. Daschner M, Gfrorer S, Zachariou Z, Mehls O, Schaefer F (2002) Laparoscopic Tenckhoff catheter implantation in kids. Perit Dial Int 22:22-26
  122. Jwo SC, Chen KS, Lin YY (2003) Video-assisted laparoscopic procedures in peritoneal dialysis. Surg Endosc 17:1666-1670
  123. Wang JY, Chen FM, Huang TJ, Hou MF, Huang CJ, Chan HM, Cheng KI, Cheng HC, Hsieh JS (2005) Laparoscopic assisted placement of peritoneal dialysis catheters for chosen sufferers with earlier stomach operation. J Make investments Surg 18:59-62
  124. Lu CT, Watson DI, Elias TJ, Faull RJ, Clarkson AR, Bannister KM (2003) Laparoscopic placement of peritoneal dialysis catheters: 7 years expertise. ANZ J Surg 73:109-111
  125. Numanoglu A, Rasche L, Roth MA, McCulloch MI, Rode H (2008) Laparoscopic insertion with tip suturing, omentectomy, and ovariopexy improves lifespan of peritoneal dialysis catheters in kids. J Laparoendosc Adv Surg Tech A 18:302-305
  126. Frost JH, Bagul A A short recap of ideas and surgical manoeuvres to reinforce optimum final result of surgically positioned peritoneal dialysis catheters. Int J Nephrol 2012:251584
  127. Ogunc G (2005) Minilaparoscopic extraperitoneal tunneling with omentopexy: a brand new method for CAPD catheter placement. Perit Dial Int 25:551-555
  128. McIntosh G, Hurst PA, Younger AE (1985) The ‘omental hitch’ for the prevention of obstruction to peritoneal dialysis catheters. Br J Surg 72:880
  129. Crabtree JH, Fishman A (1999) Laparoscopic omentectomy for peritoneal dialysis catheter circulate obstruction: a case report and assessment of the literature. Surg Laparosc Endosc Percutan Tech 9:228-233
  130. Crabtree JH, Fishman A (2003) Selective efficiency of prophylactic omentopexy throughout laparoscopic implantation of peritoneal dialysis catheters. Surg Laparosc Endosc Percutan Tech 13:180-184
  131. Goh YH (2008) Omental folding: a novel laparoscopic method for salvaging peritoneal dialysis catheters. Perit Dial Int 28:626-631
  132. Harvey EA (2001) Peritoneal entry in kids. Perit Dial Int 21 Suppl 3:S218-222
  133. Cribbs RK, Greenbaum LA, Heiss KF (2010) Danger components for early peritoneal dialysis catheter failure in kids. J Pediatr Surg 45:585-589
  134. Lewis M, Webb N, Smith T, Roberts D (1995) Routine omentectomy will not be required in kids present process power peritoneal dialysis. Adv Perit Dial 11:293-295
  135. Phan J, Stanford S, Zaritsky JJ, DeUgarte DA Danger components for morbidity and mortality in pediatric sufferers with peritoneal dialysis catheters. J Pediatr Surg 48:197-202
  136. Ladd AP, Breckler FD, Novotny NM (2011) Influence of main omentectomy on longevity of peritoneal dialysis catheters in kids. Am J Surg 201:401-404; dialogue 404-405
  137. Flanigan M, Gokal R (2005) Peritoneal catheters and exit-site practices towards optimum peritoneal entry: a assessment of present developments. Perit Dial Int 25:132-139
  138. Crabtree JH (2003) Development and use of stencils in planning for peritoneal dialysis catheter implantation. Perit Dial Int 23:395-398
  139. Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, Kuijper EJ, Li PK, Lye WC, Mujais S, Paterson DL, Fontan MP, Ramos A, Schaefer F, Uttley L (2005) Peritoneal dialysis-related infections suggestions: 2005 replace. Perit Dial Int 25:107-131
  140. Dombros N, Dratwa M, Feriani M, Gokal R, Heimburger O, Krediet R, Plum J, Rodrigues A, Selgas R, Struijk D, Verger C (2005) European finest observe pointers for peritoneal dialysis. 3 Peritoneal entry. Nephrol Dial Transplant 20 Suppl 9:ix8-ix12
  141. Batey CA, Crane JJ, Jenkins MA, Johnston TD, Munch LC (2002) Mini-laparoscopy-assisted placement of Tenckhoff catheters: an improved method to facilitate peritoneal dialysis. J Endourol 16:681-684
  142. Varela JE, Elli EF, Vanuno D, Horgan S (2003) Mini-laparoscopic placement of a peritoneal dialysis catheter. Surg Endosc 17:2025-2027
  143. Yun EJ, Meng MV, Brennan TV, McAninch JW, Santucci RA, Rogers SJ (2003) Novel microlaparoscopic method for peritoneal dialysis catheter placement. Urology 61:1026-1028
  144. Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F (2012) Consensus pointers for the prevention and remedy of catheter-related infections and peritonitis in pediatric sufferers receiving peritoneal dialysis: 2012 replace. Perit Dial Int 32 Suppl 2:S32-86
  145. Watson AR, Gartland C (2001) Pointers by an Advert Hoc European Committee for Elective Persistent Peritoneal Dialysis in Pediatric Sufferers. Perit Dial Int 21:240-244
  146. Ranganathan D, Baer R, Fassett RG, Williams N, Han T, Watson M, Healy H (2010) Randomised managed trial to find out the suitable time to provoke peritoneal dialysis after insertion of catheter to minimise issues (Well timed PD research). BMC Nephrol 11:11
  147. (2004) The CARI pointers. Proof for peritonitis remedy and prophylaxis: timing of graduation of dialysis after peritoneal dialysis catheter insertion. Nephrology (Carlton) 9 Suppl 3:S76-77
  148. Gokal R, Alexander S, Ash S, Chen TW, Danielson A, Holmes C, Joffe P, Moncrief J, Nichols Okay, Piraino B, Prowant B, Slingeneyer A, Stegmayr B, Twardowski Z, Vas S (1998) Peritoneal catheters and exit-site practices towards optimum peritoneal entry: 1998 replace. (Official report from the Worldwide Society for Peritoneal Dialysis). Perit Dial Int 18:11-33
  149. Ghaffari A (2012) Pressing-start peritoneal dialysis: a top quality enchancment report. Am J Kidney Dis 59:400-408
  150. Track JH, Kim GA, Lee SW, Kim MJ (2000) Scientific outcomes of fast full-volume alternate one 12 months after peritoneal catheter implantation for CAPD. Perit Dial Int 20:194-199
  151. Robison RJ, Leapman SB, Wetherington GM, Hamburger RJ, Fineberg NS, Filo RS (1984) Surgical issues of steady ambulatory peritoneal dialysis. Surgical procedure 96:723-730
  152. Stegmayr BG (1993) Paramedian insertion of Tenckhoff catheters with three purse-string sutures reduces the danger of leakage. Perit Dial Int 13 Suppl 2:S124-126
  153. Adamson AS, Kelleher JP, Snell ME, Hulme B (1992) Endoscopic placement of CAPD catheters: a assessment of 100 procedures. Nephrol Dial Transplant 7:855-857
  154. Copley JB, Lindberg JS, Tapia NP, Again SN, Snyder PA (1994) Peritoneoscopic placement of Swan neck peritoneal dialysis catheters. Perit Dial Int 14:295-296
  155. Zaman F, Pervez A, Atray NK, Murphy S, Work J, Abreo KD (2005) Fluoroscopy-assisted placement of peritoneal dialysis catheters by nephrologists. Semin Dial 18:247-251
  156. Tsimoyiannis EC, Siakas P, Glantzounis G, Toli C, Sferopoulos G, Pappas M, Manataki A (2000) Laparoscopic placement of the Tenckhoff catheter for peritoneal dialysis. Surg Laparosc Endosc Percutan Tech 10:218-221
  157. Ozener C, Bihorac A, Akoglu E (2001) Technical survival of CAPD catheters: comparability between percutaneous and traditional surgical placement strategies. Nephrol Dial Transplant 16:1893-1899
  158. Medani S, Shantier M, Hussein W, Wall C, Mellotte G (2011) A comparative evaluation of percutaneous and open surgical strategies for peritoneal catheter placement. Perit Dial Int 32:628-635
  159. Pastan S, Gassensmith C, Manatunga AK, Copley JB, Smith EJ, Hamburger RJ (1991) Potential comparability of peritoneoscopic and surgical implantation of CAPD catheters. ASAIO Trans 37:M154-156
  160. Gadallah MF, Pervez A, el-Shahawy MA, Sorrells D, Zibari G, McDonald J, Work J (1999) Peritoneoscopic versus surgical placement of peritoneal dialysis catheters: a potential randomized research on final result. Am J Kidney Dis 33:118-122
  161. Rosenthal MA, Yang PS, Liu IL, Sim JJ, Kujubu DA, Rasgon SA, Yeoh HH, Abcar AC (2008) Comparability of outcomes of peritoneal dialysis catheters positioned by the fluoroscopically guided percutaneous methodology versus immediately visualized surgical methodology. J Vasc Interv Radiol 19:1202-1207
  162. Atapour A, Asadabadi HR, Karimi S, Eslami A, Beigi AA Evaluating the outcomes of open surgical process and percutaneously peritoneal dialysis catheter (PDC) insertion utilizing laparoscopic needle: A two month follow-up research. J Res Med Sci 16:463-468
  163. Voss D, Hawkins S, Poole G, Marshall M Radiological versus surgical implantation of first catheter for peritoneal dialysis: a randomized non-inferiority trial. Nephrol Dial Transplant 27:4196-4204
  164. Xie H, Zhang W, Cheng J, He Q (2012) Laparoscopic versus open catheter placement in peritoneal dialysis sufferers: a scientific assessment and meta-analysis. BMC Nephrol 13:69
  165. Hagen SM, van Alphen AM, Ijzermans JN, Dor FJ Laparoscopic versus open peritoneal dialysis catheter insertion, the LOCI-trial: a research protocol. BMC Surg 11:35
  166. Stone ML, LaPar DJ, Barcia JP, Norwood VF, Mulloy DP, McGahren ED, Rodgers BM, Kane BJ (2013) Surgical outcomes evaluation of pediatric peritoneal dialysis catheter operate in a rural area. J Pediatr Surg 48:1520-1527
  167. Macchini F, Valade A, Ardissino G, Testa S, Edefonti A, Torricelli M, Luzzani S (2006) Persistent peritoneal dialysis in kids: catheter associated issues. A single centre expertise. Pediatr Surg Int 22:524-528
  168. Stringel G, McBride W, Weiss R (2008) Laparoscopic placement of peritoneal dialysis catheters in kids. J Pediatr Surg 43:857-860
  169. Subramaniam R (2008) Laparoscopic Insertion of Peritoneal Dialysis Catheters in Youngsters – The New Gold Normal? J Pediatr Urol 4 Complement 1:S17
  170. Copeland DR, Blaszak RT, Tolleson JS, Saad DF, Jackson RJ, Smith SD, Kokoska ER (2008) Laparoscopic Tenckhoff catheter placement in kids utilizing a securing suture within the pelvis: comparability to the open strategy. J Pediatr Surg 43:2256-2259
  171. Mital S, Fried L, Piraino B (2004) Bleeding issues related wtih peritoneal dialysis catheter insertion. Perit Dial Int 24:478-480
  172. Singal Okay, Segel DP, Bruns FJ, Fraley DS, Adler S, Julian TB (1986) Genital edema in sufferers on steady ambulatory peritoneal dialysis. Report of three circumstances and assessment of the literature. Am J Nephrol 6:471-475
  173. Schroder CH, Rieu P, de Jong MC (1993) Peritoneal laceration: a uncommon explanation for scrotal edema in a 2-year-old boy. Adv Perit Dial 9:329-330
  174. Adeniyi M, Wiggins B, Solar Y, Servilla KS, Hartshorne MF, Tzamaloukas AH (2009) Scrotal edema secondary to fluid imbalance in sufferers on steady peritoneal dialysis. Adv Perit Dial 25:68-71
  175. Helfrich GB, Pechan BW, Alifani MR (1983) Discount of catheter issues with lateral placement. . Perit Dial Bull 2:132-133
  176. Digenis G, khanna R, Mathews R (1982) Stomach wall hernias in sufferers present process steady ambulatory peritoneal dialysis. Perit Dial Bull:115
  177. Rusthoven E, van de Kar NA, Monnens LA, Schroder CH (2004) Fibrin glue used efficiently in peritoneal dialysis catheter leakage in kids. Perit Dial Int 24:287-289
  178. Joffe P (1993) Peritoneal dialysis catheter leakage handled with fibrin glue. Nephrol Dial Transplant 8:474-476
  179. Sojo ET, Grosman MD, Monteverde ML, Bailez MM, Delgado N (2004) Fibrin glue is beneficial in stopping early dialysate leakage in kids on power peritoneal dialysis. Perit Dial Int 24:186-190
  180. Yoshino A, Honda M, Ikeda M, Tsuchida S, Hataya H, Sakazume S, Tanaka Y, Shishido S, Nakai H (2004) Advantage of the cuff-shaving process in kids with power an infection. Pediatr Nephrol 19:1267-1272
  181. Crabtree JH, Burchette RJ (2005) Surgical salvage of peritoneal dialysis catheters from power exit-site and tunnel infections. Am J Surg 190:4-8
  182. Wu YM, Tsai MK, Chao SH, Tsai TJ, Chang KJ, Lee PH (1999) Surgical administration of refractory exit-site/tunnel an infection of Tenckhoff catheter: technical improvements of partial replantation. Perit Dial Int 19:451-454
  183. Juergensen PH, Murphy AL, Pherson KA, Chorney WS, Kliger AS, Finkelstein FO (1999) Tidal peritoneal dialysis to realize consolation in power peritoneal dialysis sufferers. Adv Perit Dial 15:125-126
  184. Ash SR (2003) Persistent peritoneal dialysis catheters: overview of design, placement, and elimination procedures. Semin Dial 16:323-334
  185. Teitelbaum I, Burkart J (2003) Peritoneal dialysis. Am J Kidney Dis 42:1082-1096
  186. Mujais S, Story Okay (2006) Peritoneal dialysis within the US: analysis of outcomes in up to date cohorts. Kidney Int Suppl:S21-26
  187. Rinaldi S, Sera F, Verrina E, Edefonti A, Gianoglio B, Perfumo F, Sorino P, Zacchello G, Cutaia I, Lavoratti G, Leozappa G, Pecoraro C, Rizzoni G (2004) Persistent peritoneal dialysis catheters in kids: a fifteen-year expertise of the Italian Registry of Pediatric Persistent Peritoneal Dialysis. Perit Dial Int 24:481-486
  188. Cacho CP, Tessman MJ, Newman LN, Friedlander MA (1995) Influx obstruction attributable to kinking of coiled catheters throughout placement. Perit Dial Int 15:276-278
  189. Yilmazlar T, Kirdak T, Bilgin S, Yavuz M, Yurtkuran M (2006) Laparoscopic findings of peritoneal dialysis catheter malfunction and administration outcomes. Perit Dial Int 26:374-379
  190. Xie JY, Ren H, Kiryluk Okay, Chen N Peritoneal dialysis outflow failure from omental wrapping identified by catheterography. Am J Kidney Dis 56:1006-1011
  191. Xie JY, Ren H, Kiryluk Okay, Chen N (2010) Peritoneal dialysis outflow failure from omental wrapping identified by catheterography. Am J Kidney Dis 56:1006-1011
  192. Diaz-Buxo JA (1998) Administration of peritoneal catheter malfunction. Perit Dial Int 18:256-259
  193. Stonehill WH, Smith DP, Noe HN (1995) Radiographically documented fecal impaction inflicting peritoneal dialysis catheter malfunction. J Urol 153:445-446
  194. Kim HJ, Lee TW, Ihm CG, Kim MJ (2002) Use of fluoroscopy-guided wire manipulation and/or laparoscopic surgical procedure within the restore of malfunctioning peritoneal dialysis catheters. Am J Nephrol 22:532-538
  195. Scabardi M, Ronco C, Chiaramonte S, Feriani M, Agostini F, La Greca G (1992) Dynamic catheterography within the early analysis of peritoneal catheter malfunction. Int J Artif Organs 15:358-364
  196. Stuart S, Sales space TC, Money CJ, Hameeduddin A, Goode JA, Harvey C, Malhotra A (2009) Problems of steady ambulatory peritoneal dialysis. Radiographics 29:441-460
  197. Litherland J, Lupton EW, Ackrill PA, Venning M, Sambrook P (1994) Computed tomographic peritoneography: CT manifestations within the investigation of leaks and irregular collections in sufferers on CAPD. Nephrol Dial Transplant 9:1449-1452
  198. Hollett MD, Marn CS, Ellis JH, Francis IR, Swartz RD (1992) Problems of steady ambulatory peritoneal dialysis: analysis with CT peritoneography. AJR Am J Roentgenol 159:983-989
  199. Cakir B, Kirbas I, Cevik B, Ulu EM, Bayrak A, Coskun M (2008) Problems of steady ambulatory peritoneal dialysis: analysis with CT. Diagn Interv Radiol 14:212-220
  200. Maxwell AJ, Boggis CR, Sambrook P (1990) Computed tomographic peritoneography within the investigation of stomach wall and genital swelling in sufferers on steady ambulatory peritoneal dialysis. Clin Radiol 41:100-104
  201. Sahani MM, Mukhtar KN, Boorgu R, Leehey DJ, Popli S, Ing TS (2000) Tissue plasminogen activator can successfully declot peritoneal dialysis catheters. Am J Kidney Dis 36:675
  202. Sakarcan A, Stallworth JR (2002) Tissue plasminogen activator for occluded peritoneal dialysis catheter. Pediatr Nephrol 17:155-156
  203. Stadermann MB, Rusthoven E, van de Kar NC, Hendriksen A, Monnens LA, Schroder CH (2002) Native fibrinolytic remedy with urokinase for peritoneal dialysis catheter obstruction in kids. Perit Dial Int 22:84-86
  204. Shea M, Hmiel SP, Beck AM (2001) Use of tissue plasminogen activator for thrombolysis in occluded peritoneal dialysis catheters in kids. Adv Perit Dial 17:249-252
  205. Zorzanello MM, Fleming WJ, Prowant BE (2004) Use of tissue plasminogen activator in peritoneal dialysis catheters: a literature assessment and one middle’s expertise. Nephrol Nurs J 31:534-537
  206. Dobrashian RD, Conway B, Hutchison A, Gokal R, Taylor PM (1999) The repositioning of migrated Tenckhoff steady ambulatory peritoneal dialysis catheters below fluoroscopic management. Br J Radiol 72:452-456
  207. Savader SJ, Lund G, Scheel PJ, Prescott C, Feeley N, Singh H, Osterman FA, Jr. (1997) Information wire directed manipulation of malfunctioning peritoneal dialysis catheters: a important evaluation. J Vasc Interv Radiol 8:957-963
  208. Ozyer U, Harman A, Aytekin C, Boyvat F, Ozdemir N (2009) Correction of displaced peritoneal dialysis catheters with an angular stiff rod. Acta Radiol 50:139-143
  209. Siegel RL, Nosher JL, Gesner LR (1994) Peritoneal dialysis catheters: repositioning with new fluoroscopic method. Radiology 190:899-901
  210. Moss JS, Minda SA, Newman GE, Dunnick NR, Vernon WB, Schwab SJ (1990) Malpositioned peritoneal dialysis catheters: a important reappraisal of correction by stiff-wire manipulation. Am J Kidney Dis 15:305-308
  211. Kappel JE, Ferguson GM, Kudel RM, Kudel TA, Lawlor BJ, Pylypchuk GB (1995) Stiff wire manipulation of peritoneal dialysis catheters. Adv Perit Dial 11:202-207
  212. Simons ME, Pron G, Voros M, Vanderburgh LC, Rao PS, Oreopoulos DG (1999) Fluoroscopically-guided manipulation of malfunctioning peritoneal dialysis catheters. Perit Dial Int 19:544-549
  213. Diaz-Buxo JA, Turner MW, Nelms M (1997) Fluoroscopic manipulation of Tenckhoff catheters: final result evaluation. Clin Nephrol 47:384-388
  214. Jones B, McLaughlin Okay, Mactier RA, Porteous C (1998) Tenckhoff catheter salvage by closed stiff-wire manipulation with out fluoroscopic management. Perit Dial Int 18:415-418
  215. Plaza MM, Rivas MC, Dominguez-Viguera L (2001) Fluoroscopic manipulation can be helpful for malfunctioning swan-neck peritoneal catheters. Perit Dial Int 21:193-196
  216. Gadallah MF, Arora N, Arumugam R, Moles Okay (2000) Function of Fogarty catheter manipulation in administration of migrated, nonfunctional peritoneal dialysis catheters. Am J Kidney Dis 35:301-305
  217. Brandt CP, Ricanati ES (1996) Use of laparoscopy within the administration of malfunctioning peritoneal dialysis catheters. Adv Perit Dial 12:223-226
  218. Kimmelstiel FM, Miller RE, Molinelli BM, Lorch JA (1993) Laparoscopic administration of peritoneal dialysis catheters. Surg Gynecol Obstet 176:565-570
  219. Amerling R, Maele DV, Spivak H, Lo AY, White P, Beaton H, Rudick J (1997) Laparoscopic salvage of malfunctioning peritoneal catheters. Surg Endosc 11:249-252
  220. Barone GW, Johnson DD, Webb JW (1998) A sensible strategy to laparoscopic surgical procedure for malfunctioning peritoneal dialysis catheters. J Laparoendosc Adv Surg Tech A 8:19-23
  221. Yilmazlar T, Yavuz M, Ceylan H (2001) Laparoscopic administration of malfunctioning peritoneal dialysis catheters. Surg Endosc 15:820-822
  222. Numanoglu A, McCulloch MI, Van Der Pool A, Millar AJ, Rode H (2007) Laparoscopic salvage of malfunctioning Tenckhoff catheters. J Laparoendosc Adv Surg Tech A 17:128-130
  223. Ovnat A, Dukhno O, Pinsk I, Peiser J, Levy I (2002) The laparoscopic choice within the administration of peritoneal dialysis catheter revision. Surg Endosc 16:698-699
  224. Lee M, Donovan JF (2002) Laparoscopic omentectomy for salvage of peritoneal dialysis catheters. J Endourol 16:241-244
  225. Hughes CR, Angotti DM, Jubelirer RA (1994) Laparoscopic repositioning of a steady ambulatory peritoneal dialysis (CAPD) catheter. Surg Endosc 8:1108-1109
  226. Ogunc G (2002) Malfunctioning peritoneal dialysis catheter and accompanying surgical pathology repaired by laparoscopic surgical procedure. Perit Dial Int 22:454-462
  227. Crabtree JH, Fishman A (1996) Laparoscopic epiplopexy of the better omentum and epiploic appendices within the salvaging of dysfunctional peritoneal dialysis catheters. Surg Laparosc Endosc 6:176-180
  228. Kleinpeter MA, Krane NK (2006) Perioperative administration of peritoneal dialysis sufferers: assessment of stomach surgical procedure. Adv Perit Dial 22:119-123
  229. Goel S, Ribby KJ, Kathuria P, Khanna R (1998) Momentary stoppage of peritoneal dialysis when laparoscopic procedures are carried out on sufferers present process CAPD/CCPD: a change in coverage. Adv Perit Dial 14:80-82
  230. Magnuson TH, Bender JS, Campbell KA, Ratner LE (1995) Cholecystectomy within the peritoneal dialysis affected person. Distinctive benefits to the laparoscopic strategy. Surg Endosc 9:908-909
  231. Lin YP, Ng YY, Shyr YM, Chu YK, Huang TP (1996) Optimum time to restart standard CAPD after laparoscopic revision of CAPD catheters. Perit Dial Int 16:538-539
  232. Jonler M, Lund L, Kyrval H (2003) Laparoscopic correction and fixation of displaced peritoneal dialysis catheters. Int Urol Nephrol 35:85-86
  233. Zoland MP, Loubeau JM, Krapf R, Zabetakis PM (1997) A simplified laparoscopic salvage method for malfunctioning power peritoneal dialysis catheters. Perit Dial Int 17:610-612
  234. Zakaria HM (2011) Laparoscopic administration of malfunctioning peritoneal dialysis catheters. Oman Med J 26:171-174

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