Selective performance of prophylactic omentopexy during laparoscopic implantation of peritoneal dialysis catheters

Omental entrapment of the peritoneal dialysis catheter remains a common cause of flow dysfunction. Prophylactic omentectomy during catheter implantation is still followed with an incidence of flow obstruction as high as 10%. We describe indications and a technique for selective performance of omentopexy during laparoscopic catheter implantation that resulted in only a 0.7% obstruction rate in 153 consecutive patients as compared with a 12.8% rate in a preceding group of 78 consecutive patients. Laparoscopic omentopexy was performed during 9.2% of implant procedures and only when the omentum was found to extend to the retrovesical space. The procedure is simple, quick, and inexpensive to perform. Employing selective criteria for omentopexy eliminates the performance of unnecessary procedures. Actuarial analysis demonstrates that an operative strategy of selectively performing omentopexy for redundant omentum significantly improves catheter survival free of flow dysfunction (P < 0.0001).