Laparoscopic management of peritoneal dialysis catheters

Laparoscopic surgical techniques were used for peritoneal dialysis catheter placement or for revision in patients with previous extensive abdominal surgical treatment, multiple prior catheter insertions or dysfunctional catheters with outflow obstruction. Nineteen laparoscopic procedures were performed upon 16 patients between July 1990 and January 1992. All patients were chosen for the laparoscopic approach because of the complicated nature of previous incisions or in an attempt to salvage existing catheters. In five patients, open laparoscopy was performed with the blunt Hasson trocar, and in the remaining patients, closed techniques were used to establish the pneumoperitoneum. Dysfunctional catheters were revised by adhesiolysis, partial omental resection and subtotal omentectomy. New catheters were easily placed percutaneously, sometimes after extensive adhesiolysis, using direct laparoscopic guidance. All patients had functioning catheters postoperatively. Two catheters subsequently failed because of dislodgement and recurrent obstruction. The overall success rate for the entire series was 75 percent. We conclude that laparoscopy will be a useful addition to the surgical armamentarium in managing patients on peritoneal dialysis, particularly as this mode of renal replacement therapy rapidly expands.