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Introduction: End stage renal disease (ESRD) is permanent kidney failure that requires dialysis or renal transplantation. Peritoneal dialysis (PD) for ESRD in adult patients was introduced in our hospital in late 1960's. In 1998, following growing indications for laparoscopy in our hospital, laparoscopic placement of catethers began and since then it has been the only method we employ. Many of our patients, thanking to PD, overcame the time gap to a kidney transplantation sustaining good quality of life. Various factors affect outcomes of this type of treatment and we wanted to compare our results to current literature. Methods / patients: Total of 64 patients were all hospitalized at Department of Nephrology, Clinical Hospital Centre Split between 01.01.2008. and 01.04.2014. They all underwent laparoscopic placement of peritoneal dialysis catether at Department of Surgery. Their medical histories were reviewed retrospectively. In all cases same procedure protocol was used: laparoscopic visualization of preperitoneal tunnelling and positioning straight Tenckhoff catether in Douglas's pouch. Three different surgeons performed the procedures. Results: There was no perioperative mortality nor other complications requiring early reintervention. 22 (34.3%) catethers are still used for dialysis with mean catether longevity of 19.5, 95% CI [11.4, 27.5] months. Eight (12.5%) patients died during follow-up after mean of 27.8, CI [13.8, 41.7] months on CAPD. Sixteen patients (25%) received a renal transplant after mean of 22.1, CI [15.3, 28.9] months on CAPD. The rest of 18 (28.2%) patients required catether removal and returned to intermittent haemodialysis after median of 12 (range 0 - 48) months on CAPD. Reasons were inadequate peritoneal filtration in 7 (39%) patients, frequent peritonitis in 6 (33%) patients, peritoneal fluid loss in 4 (22%) and one (6%) primary failure because of extensive intraabdominal adhesions. Conclusion: Laparoscopic placement of peritoneal dialysis catheters is a safe and effective procedure. Changes in surgical technique are being considered to prevent catether malfunction as well as improvement of ambulatory care and patient education. |
