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Surgical Treatment for Encapsulating Peritoneal Sclerosis: 24 Years' Experience
Hideki Kawanishi1,2, Masataka Banshodani3, Masahiro Yamashita3
1Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan h-kawanishi@tuschiya-hp.jp.
Summary
Surgical intervention for Encapsulating peritoneal sclerosis (EPS) significantly improves outcomes. While complications exist, surgery offers a better prognosis for patients with bowel obstruction, challenging its previous contraindication.
Area of Science:
- Nephrology
- Gastroenterology
- Surgical Oncology
Background:
- Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis.
- High mortality rates in EPS are linked to bowel obstruction, with surgery historically contraindicated.
- Surgical enterolysis is now considered for refractory bowel obstruction in EPS patients.
Purpose of the Study:
- To evaluate the outcomes of surgical intervention for Encapsulating peritoneal sclerosis (EPS).
- To assess the association between peritoneal deterioration and clinical outcomes in EPS patients undergoing surgery.
Main Methods:
- Retrospective observational study of 243 patients with EPS undergoing surgical intervention.
- Data collected between November 1993 and October 2017 at a single center.
- Severity of intestinal damage assessed by grade-3 peritoneal calcification and small intestinal wall degeneration.
Main Results:
- A total of 318 EPS surgeries were performed, with 58 requiring re-surgery due to recurrence.
- EPS-related death occurred in 61 patients (25.1%), with 15 postoperative deaths.
- Actuarial survival rates at 8 years post-diagnosis were 53%, with peritoneal calcification and intestinal degeneration impacting mortality.
Conclusions:
- Surgical intervention yields excellent outcomes for Encapsulating peritoneal sclerosis (EPS).
- The extent of peritoneal deterioration significantly influences clinical outcomes.
- EPS is no longer considered an invariably fatal complication due to surgical advancements.