Seventeen years' experience of surgical options for encapsulating peritoneal sclerosis

Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD). The mortality rate for EPS has been high, primarily because of complications related to bowel obstruction. However recent advances in clinical research have established the pathogenesis and course of the condition and a treatment strategy. The final therapeutic option for EPS is surgical enterolysis, and we have performed 239 surgical procedures in 181 patients and observed favorable outcomes. Of 181 patients opting for surgery 64 (35.40%) died. Death was related to EPS in 33 patients (18.2%), including 14 who died postoperatively. The overall survival rate at 1, 2, 3, 5, and 8 years after diagnosis was 93%, 83%, 78%, 71%, and 60% respectively. The survival rate for EPS-related death at 1, 2, 3, 5, and 8 years after diagnosis was 95%, 90%, 87%, 81%, and 74% respectively. Median survival after diagnosis, considering death from any cause and death from EPS, was 43.9 months and 35.7 months respectively. In conclusion, we present favorable outcomes with EPS surgery in 181 patients encountered over a period of 17years. These data reconfirm that surgical treatment is essential for EPS patients. Encapsulating peritoneal sclerosis may no longer be a fatal complication and can be improved with accurate diagnosis and treatment.