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Primary laparoscopic placement of peritoneal dialysis catheters in children and young adults
M S Lessin1, F I Luks, A S Brem
1Division of Pediatric Surgery, Brown University School of Medicine and Hasbro Children's Hospital, 2 Dudley Street, Providence, RI 02905, USA.
Insights
Gasless laparoscopy offers a minimally invasive approach for placing peritoneal dialysis catheters in pediatric patients, enabling rapid initiation of dialysis and short hospital stays.
Area of Science:
- Pediatric Surgery
- Nephrology
- Minimally Invasive Procedures
Background:
- Traditional peritoneal dialysis catheter placement in children often involves pelvic suturing.
- A novel gasless laparoscopy technique is presented for pediatric and young adult patients.
Purpose of the Study:
- To evaluate the feasibility and outcomes of primary laparoscopic peritoneal dialysis catheter placement in children and young adults.
- To assess the safety, efficacy, and long-term patency of this minimal access technique.
Main Methods:
- A single umbilical port was utilized for laparoscopic instruments and catheter insertion.
- Omentectomy was performed, and the catheter tip was secured in a dependent position.
- Follow-up data included dialysis initiation, hospitalizations, and clinical outcomes over a mean of 15 months.
Main Results:
- Diet and dialysis were initiated on postoperative days 0 and 1, respectively.
- Four patients experienced seven complications, such as catheter leakage and fimbrial entanglement.
- Long-term, revision-free catheter survival was 67% at 24 months.
Conclusions:
- Gasless laparoscopy provides a minimal access method for peritoneal dialysis catheter placement in pediatric patients.
- The technique facilitates early dialysis initiation and short hospital stays.
- Securing the catheter tip and performing omentectomy contribute to acceptable long-term catheter patency.
Background:
Primary placement of peritoneal dialysis catheters in children often requires suturing of the catheter into the pelvis. We describe our experience with a gasless laparoscopy technique in children and young adults.
Methods:
During an 18-month period, 12 patients (mean age, 14 years) underwent primary laparoscopic placement of peritoneal dialysis catheters. A single umbilical port was used for abdominal wall elevation, telescope, and catheter. A needleholder was introduced via an accessory port at the future catheter exit site or through the umbilical port. Omentectomy was performed through the umbilical incision. The catheter was tunneled to the lateral abdominal wall. Follow-up data (>/= 15 months) included time to initiation of dialysis, hospitalization, and outcome. End points were cure, transplantation, or death.
Results:
Diet was started on the day of surgery and dialysis on the following day. Four patients had seven complications, including leakage and entanglement of the catheter in tubal fimbriae. Long-term revision-free catheter survival was 67% at 24 months.
Conclusions:
This minimal access technique for primary placement of peritoneal dialysis catheters includes securing of the catheter tip in a dependent location and omentectomy. It allows nearly immediate use of the catheter, leads to a minimal hospital stay, and has acceptable long-term patency.