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Published on: July 19, 2018
Laparoscopic peritoneal dialysis catheter insertion with omentopexy-sparing the omentum in children
Beytullah Yağız1, Demet Tekcan Karalı2, Hülya Nalçacıoğlu2
1Ondokuz Mayıs University, Samsun, Turkey. beytullahyagiz@gmail.com.
Insights
Omentopexy during laparoscopic peritoneal dialysis catheter placement in children is a feasible technique. While catheter loss was higher in the omentopexy group, it was not linked to the procedure itself, suggesting omentopexy is a viable alternative to omentectomy.
Area of Science:
- Pediatric Surgery
- Nephrology
- Minimally Invasive Surgery
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is crucial for pediatric renal replacement therapy.
- Catheter obstruction by the omentum is a common complication, leading to morbidity.
- Omentectomy is often performed to prevent obstruction, but omentopexy spares the omentum for future use.
Purpose of the Study:
- To present the technique of laparoscopic peritoneal dialysis catheter placement in children with concurrent omentopexy.
- To evaluate the feasibility and outcomes of laparoscopic omentopexy versus omentectomy in pediatric CAPD catheter insertion.
Main Methods:
- Retrospective evaluation of pediatric patients undergoing laparoscopic peritoneal dialysis catheter placement.
- Comparison of outcomes between patients who had concomitant omentopexy (n=12) and omentectomy (n=18).
Main Results:
- Catheter loss occurred in 4 patients (33%) in the omentopexy group and 3 patients (17%) in the omentectomy group.
- No catheter losses were attributed to omental obstruction in either group.
- A higher rate of previous abdominal surgery was noted in the omentopexy group (50%) compared to the omentectomy group (17%).
Conclusions:
- Laparoscopic peritoneal dialysis catheter placement with omentopexy is a feasible and reproducible technique in children.
- Omentopexy offers an alternative to omentectomy, preserving the omentum for potential future reconstructive surgery.
- The observed higher catheter loss in the omentopexy group may be confounded by a greater prevalence of prior abdominal operations.
Introduction:
Continuous ambulatory peritoneal dialysis is an important modality of renal replacement therapy in children. Catheter dysfunction (commonly obstruction) is a major cause of morbidity and is a significant concern that hampers renal replacement therapy. As omentum is a significant cause of obstruction, some recommend routine omentectomy during insertion of the peritoneal dialysis catheter. Omentopexy rather than omentectomy has been described in adults to spare the omentum as it may be needed as a spare part in many conditions. Laparoscopic approach is commonly preferred as it provides global evaluation of the peritoneal space, proper location of the catheteral end in the pelvis and lesser morbidity due to inherent minimally invasive nature.
Aim:
The aim of this study is to present the technique of laparoscopic peritoneal dialysis catheter placement in children with concurrent omentopexy.
Methods:
We retrospectively evaluated our patients who underwent laparoscopic placement of peritoneal dialysis catheter with concomitant omentopexy or omentectomy.
Results:
A total of 30 patients were enrolled who received either omentectomy (n = 18) or omentopexy (n = 12). Four catheters were lost in the omentopexy group (33%) and 3 in the omentectomy group (17%), but none were related to omental obstruction. Three out of 4 patients in the omentopexy group and 2 out of 3 patients in the omentectomy group had a previous abdominal operation as a potential cause of catheter loss. Previous history of abdominal surgery was present in 6 patients (50%) in the omentopexy group and 3 patients (17%) in the omentectomy group.
Conclusions:
As omentum was associated with catheter failure, omentectomy is commonly recommended. Alternatively, omentopexy can be preferred in children to spare an organ that may potentially be necessary for many surgical reconstructive procedures in the future. Laparoscopic peritoneal dialysis catheter placement with concomitant omentopexy appears as a feasable and reproducible technique. Although the catheter loss seems to be higher in the omentopexy group, none was related with the omentopexy procedure and may be related to the higher rate of history of previous abdominal operations in this group.
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