Laparoscopic Vs Open Peritoneal Dialysis Catheter Placement
Christina Veith, DO, Albeir Mousa, MD, Mike Broce.
Charleston Area Medical Center, Charleston, WV, USA.
OBJECTIVES - To compare immediate outcomes following laparoscopic PD catheter placement to historical controls who received open surgical PD catheter placement. METHODS - A retrospective review of patients who had PD catheter placed for dialysis. The primary end point was immediate success defined as a functional peritoneal dialysis catheter. Catheter survival was estimated using Kaplan Meier method. RESULTS - One hundred thirty-five laparoscopic catheters were placed in 121 patients (mean 1.1 attempts, standard deviation 0.34). Demographics indicated more were female (53.3%) with an average age of (mean+standard deviation) 59.8+14.0 years and BMI of 31.5+9.1 kg/m2. The majority were in renal failure (n=82, 60.7%). Diabetes was associated with a higher, but not significantly, rate of catheter related peritonitis (19.0 versus 9.8%, p=0.221).Eighty-four patients (62.2%) had previous abdominal surgery, while 22 (16.3%) a previous PD catheter placed. The LPDC group had significantly more previous abdominal surgeries (62.2 versus 13.3%; p<0.001) than OPDC. Immediate success was significantly higher in the LPDC group compared to OPDC (100 versus 80%; p=0.001). The median survival time for a functioning PD catheter was 18.4+5.9 months. The three-year cumulative catheter patency rate for LPDC (41%) was as good as or perhaps slightly better than published rates for OPDC (36%). Nearly one-third of the catheters (30%) were functioning at 5-years. CONCLUSIONS - This study demonstrates the feasibility and the immediate success benefit of laparoscopic peritoneal dialysis catheter placement over open surgery.Thirty-percent of the catheters were functioning at 5 years. This technique has the potential to be the preferred modality for PD placement.Larger studies or randomized control trials are warranted to accurately assess outcomes for laparoscopy versus open surgery.
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