Back to ePosters

Objectives: The prevalence of peritoneal dialysis (PD) use in the United States is around 6-7%. There is shortage of surgeons interested in PD catheter insertion, due to inadequate training and low referral. The Centers for Medicare and Medicaid is advocating the utilization of home dialysis, which is leading to increased PD catheter insertion. The aim of the current study is to examine outcomes and complications of LPD performed by vascular surgeons.
Methods: We performed retrospective chart review of all consecutive patients receiving laparoscopic PD (LPD) catheter placement using a single- or a two-port technique from 6/1/2008-6/30/2012. We compared operative times, intraoperative complications and 30-day complications, mortality and long-term catheter use between both techniques.
Results: A total of 97 patients underwent LPD, of whom 69 (71%) received a single-port LPD. Average operative time for single port LPD was 16.6 vs. 41.2 minutes for two-port LPD, (P <.05). Nineteen (19.6%) patients had prior abdominal surgery, of whom 5 (5.2%) required lysis of adhesions using 2-port LPD. There were no intra-operative or 30-day complications in the two-port group. One patient in the single-port group suffered an iatrogenic iliac artery injury requiring operative repair. There were no deaths within 30 days in both groups. Thirteen (14.2%) catheters were removed due to infection.Average catheter use is 16.2 months. There was no catheter migration in the two-port group and 3 in the single-port group.
Conclusions: LPD catheters can be safely and expeditiously performed by vascular surgeons with excellent results. Single-port LPD can be placed faster, but may have devastating complications. With the changes in vascular residency training, we hope these skills are maintained to match the demand for PD catheter placement. A randomized study comparing the 2 techniques is warranted.