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INVITED COMMENTARY
Year : 2019  |  Volume : 15  |  Issue : 1  |  Page : 88-89
 

Laparoscopy for continuous ambulatory peritoneal dialysis catheter placement and management of malfunctioning peritoneal dialysis catheter


Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India

Date of Submission07-Dec-2017
Date of Acceptance09-Dec-2017
Date of Web Publication4-Dec-2018

Correspondence Address:
Dr. Pankaj N Maheshwari
Department of Urology, Fortis Hospital Mulund, Mulund (West), Mumbai - 400 080, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_251_17

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How to cite this article:
Maheshwari PN. Laparoscopy for continuous ambulatory peritoneal dialysis catheter placement and management of malfunctioning peritoneal dialysis catheter. J Min Access Surg 2019;15:88-9

How to cite this URL:
Maheshwari PN. Laparoscopy for continuous ambulatory peritoneal dialysis catheter placement and management of malfunctioning peritoneal dialysis catheter. J Min Access Surg [serial online] 2019 [cited 2018 Dec 14];15:88-9. Available from: http://www.journalofmas.com/text.asp?2019/15/1/88/222438


Worldover and especially in India, there is a huge explosion in the incidence of young uncontrolled diabetics. This may lead to a dramatic increase in the incidence of chronic kidney disease.[1] Although the availability of haemodialysis (HD) is improving, there is still a huge chunk of patients who either cannot afford or have no access to HD. With a thrice a week schedule, HD further needs a huge time commitment of working hours. Peritoneal dialysis (PD) is another great option for these patients.

The advantages that PD has over HD include lower costs, simplicity of the technique, increased patient mobility and independence, fewer dietary restrictions, better blood pressure control and better patient satisfaction.[2] Disadvantages include catheter-related infections (peritonitis, exit-site/subcutaneous tract abscess), catheter malfunction or dislodgement, obstruction secondary to fibrin deposition, cuff extrusion, dialysate leakage, hernias, respiratory compromise or genital oedema.

This means that if the catheter-related problems can be reduced or avoided, there is a big and an ever-rising place for PD in our population. The ‘PD first’ policy would sustain only if there is a better catheter survival with reduced peritonitis and reduced exit site infections.[3]

Laparoscopic placement of PD catheter would provide most of these benefits.[4] As the catheter is fixed (either in the rectus sheath or by a suture), there is no risk of catheter displacement or dislodgement. Omentopexy should be an integral part of laparoscopic placement of PD catheter (especially when the omentum is long enough to reach the catheter); hence, the possibility of omental wrap with catheter malfunction is taken care of. During laparoscopy, the peritoneal exit sites can be closed properly, and the catheter cuffs can be placed under vision reducing the risks of dialysate leakage and cuff extrusion. It is possible to identify inguinal or umbilical hernias and to manage them during laparoscopy. Yes, there is a one-time cost of catheter implantation, but on a 1-year observation, the cost of PD is significantly less than HD.[5]

Percutaneous placement of PD catheter although avoids anaesthesia does not offer all the above-mentioned advantages; hence, the incidence of catheter malfunction and need to resort to HD is high.[6]

Laparoscopy also plays a very important role in salvage of a malfunctioning PD catheter. Laparoscopy facilitates the simultaneous identification and correction of problems, which may complicate PD and facilitate early return to dialysis.[7] This is usually needed for patients who had a catheter placed blindly by a percutaneous or open surgical methods. Most problems such as catheter migration, malpositioning of the catheter tip and obstruction secondary to fibrin deposition, omental wrapping or intraperitoneal adhesions can be salvaged by laparoscopy.[8] Catheter survival rate of 60%–90% at 1 year can be achieved after laparoscopy salvage.[8],[9],[10]



 
  References Top

1.
Unnikrishnan R, Anjana RM, Deepa M, Pradeepa R, Joshi SR, Bhansali A, et al. Glycemic control among individuals with self-reported diabetes in India – The ICMR-INDIAB study. Diabetes Technol Ther 2014;16:596-603.  Back to cited text no. 1
    
2.
Sinnakirouchenan R, Holley JL. Peritoneal dialysis versus hemodialysis: Risks, benefits, and access issues. Adv Chronic Kidney Dis 2011;18:428-32.  Back to cited text no. 2
    
3.
Chaudhary K, Sangha H, Khanna R. Peritoneal dialysis first: Rationale. Clin J Am Soc Nephrol 2011;6:447-56.  Back to cited text no. 3
    
4.
Maheshwari PN, Heda RS, Oswal AT, Wagholikar G, Rao N, Maheshwari SP, et al. Laparoscopy-assisted continuous ambulatory peritoneal dialysis catheter placement using amplatz dilators: A new technique with results. Urology 2014;84:1521-4.  Back to cited text no. 4
    
5.
Berger A, Edelsberg J, Inglese GW, Bhattacharyya SK, Oster G. Cost comparison of peritoneal dialysis versus hemodialysis in end-stage renal disease. Am J Manag Care 2009;15:509-18.  Back to cited text no. 5
    
6.
Afroz S, Ferdaus T, Khondokar SA, Khan MH, Hanif M. Experience of percutaneous versus surgically placed catheter for continuous ambulatory peritoneal dialysis in children with chronic kidney disease stage-V. Mymensingh Med J 2016;25:751-8.  Back to cited text no. 6
    
7.
Ogünç G. Malfunctioning peritoneal dialysis catheter and accompanying surgical pathology repaired by laparoscopic surgery. Perit Dial Int 2002;22:454-62.  Back to cited text no. 7
    
8.
Alabi A, Dholakia S, Ablorsu E. The role of laparoscopic surgery in the management of a malfunctioning peritoneal catheter. Ann R Coll Surg Engl 2014;96:593-6.  Back to cited text no. 8
    
9.
Kazemzadeh G, Modaghegh MH, Tavassoli A. Laparoscopic correction of peritoneal catheter dysfunction. Indian J Surg 2008;70:227-30.  Back to cited text no. 9
    
10.
Zakaria HM. Laparoscopic management of malfunctioning peritoneal dialysis catheters. Oman Med J 2011;26:171-4.  Back to cited text no. 10
    




 

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2004 Journal of Minimal Access Surgery
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