Laparoscopic peritoneal dialysis (LPD) surgery performed by vascular surgeons is safe and effective in patients with prior abdominal surgery (PAS)
Ahmed Mohamed, MD, Matthew Bennet, MD, Luis Gomez, Linda Le, MD, Eric Peden, MD, Carlos Bechara, MD.
The Methodist De Bakey Heart & Vascular Center, Houston, TX, USA.
Introduction:
Despite the lower cost, improved early survival, and preservation of the remaining kidney function, peritoneal dialysis (PD) is used by only 8.8% of the dialysis population in USA. Intraabdominal adhesions reported in 70-90% of patients with prior abdominal surgery (PAS) reduce the peritoneal surface area and may increase the intra- and postoperative morbidity. The objective of this study is to evaluate the outcomes of laparoscopic PD catheter placement in patients with and without previous abdominal surgery.
Methods:
Patients who had laparoscopic PD catheters placed from January 2014 to August 2016 were retrospectively reviewed. Details regarding demographics, complications, and catheter survival were collected. Kaplan-Meier analysis was performed to assess the revision free catheter survival (RFCS) and revision assisted catheter survival (RACS).
Results:
One hundred forty-two patients had had laparoscopic PD catheter placed during the study time, 82 (58%) with PAS. Lysis of adhesions (LOA) was required in 23 patients (28%) with PAS, some required extensive LOA. Demographics and comorbidities were similar but more women had PAS (65% vs. 35%, p<0.001). Seventeen patients (12%) required revision, with no difference based on PAS. Both RFCS and RACS (Figure 1) were similar in each subgroup (p=0.63 and 0.89 respectively). RACS was 81.2% vs. 75.3% at 1 year (no PAS vs. PAS) and 59.4 vs. 60.5 at 2 years. Only two minor intraoperative complications occurred, a superficial liver injury and pelvic hematoma. Three complications (0.02%) occurred within 30 days; One peritonitis and two catheter malfunctions. Overall complication rate was 25%, predominantly poor drainage (17% and 22%, PAS and no PAS), and there were no differences between the subgroups. No deaths occurred within a year of surgery.
Conclusion:
LPD and LOA can be performed safely by vascular surgeons. PD catheter placement is a safe, effective procedure and should be considered in patients with PAS. LPD catheters should be part of the vascular surgery training armamentarium as it adds a valuable option for our dialysis patients.
$$MISSING OR BAD GRAPHIC SPECIFICATION (B4D32713-5317-43F8-84CD-FD3FA7BD0C04) $$ 
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