Temporary stoppage of peritoneal dialysis when laparoscopic procedures are performed on patients undergoing...

Laparoscopic surgery has been gaining in popularity. Prior to 1995, whenever our patients had a laparoscopic procedure it was carried out with the standard precautions, and the patient stayed on peritoneal dialysis (PD). We noticed a high incidence (71.4%) of peritonitis post laparoscopic surgery. Four of the peritonitis patients had cholecystectomies and 1 had a gastrostomy for placement of a feeding tube laparoscopically. The patients' ages ranged from 31 to 74 years; 4 (80%) were females. They had been on PD for a mean of 24 months (range 6-48 months). Peritonitis was diagnosed within a mean of 22.2 hours (r: 12-36 h) post procedure. The causative organisms were Klebsiella in two cases, Staph. aureus in one, Pseudomonas in one, with no growth observed in one. Following this, we instituted a deliberate policy of temporary cessation of PD for 2 weeks post laparoscopic procedure, maintaining the patient on hemodialysis during this period. Since the adoption of this policy, we have had no peritonitis in 7 patients who have undergone laparoscopic procedures.