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Laparoscopic Tenckhoff catheter implantation in children
Markus Daschner1, Stefan Gfrörer, Zacharias Zachariou
1Department of Pediatric Surgery, University of Heidelberg, Germany.
Objective:
To assess the suitability of a laparoscopic Tenckhoff catheter implantation (TCI) technique in children.
Design:
Prospective nonrandomized controlled study.
Setting:
Laparoscopic and conventional TCIs in children were performed in a tertiary-care hospital.
Patients:
Between 1998 and 2001, 25 laparoscopic and 23 conventional TCIs were performed in 42 children. Patients in unstable clinical conditions were excluded. The laparoscope was inserted via transumbilical incision, and a forceps by percutaneous puncture. After catheter insertion, the tip was positioned in the Douglas space, and the inner cuff placed adjacent to the peritoneum, without sutures. Peritoneal dialysis was initiated immediately after surgery.
Main Outcome Measures:
Catheter-related complications during the first 4 weeks after TCI.
Results:
After laparoscopic TCI, dialysate leakage occurred in 2 of 25 cases, one of which could be managed conservatively. In 1 patient in whom dwell volume was increased immediately after laparoscopic TCI, subcutaneous leakage occurred at the site of forceps insertion. In 2 patients with severe pre-existing intra-abdominal adhesions, outflow obstruction persisted after laparoscopic TCI. Simultaneous herniotomy was performed in 2 male infants. After conventional TCI, dialysate leakage occurred in 5 of 23 cases, 1 of which could be managed conservatively. Outflow obstruction occurred in 2 cases.
Conclusion:
Laparoscopic TCI is feasible in children of all age groups, with at least equivalent functional results compared to conventional TCI. An additional advantage is the option to identify and eliminate anatomical risk factors, such as intra-abdominal adhesions or preformed inguinal hernias in male infants.