Implantation of a Peritoneal Catheter Laparoscopically and by Laparotomy.Comparison of the Two Methods

Overview

Peritoneal dialysis is one possible way how to treat patients with renal failure. An essentialprerequisite of chronic peritoneal dialysis is a long-term well functioning peritoneal catheter.The objective of the present work is to compare the incidence of complications after l aparoscopic(34 patients) and laparotomic (27 patients) implantation of a peritoneal catheter.In the group of patients after laparoscopic implantation of the catheter early leak of the dialysatealong the catheter was more frequent during the postoperative period as compared with thegroup of patients after laparotomic implantation (41 % as compared with 18.4 %). The escapeof the catheter from the pelvis minor was comparable in the two groups (14.8 % as comparedwith 11.1 %). Early infection of the tunnel along the catheter was recorded in one female patientafter laparotomic implantation of the catheter. The mean period of the laparoscopic operationwas significantly shorter as compared with the laparotomic operation (24 as compared with 30min.). Patients with early leak of the dialysate did not differ as to age total protein and serumalbumin. The group comprised however a higher ratio of diabetic patients (63 % as comparedwith 33 %).Inview of the higher rate of early leak of dialysate in the group after laparoscopic ins ertion ofthe catheter we made the following provisions: we close tightly the incisions after passage ofthe ports, we do not start with peritoneal dialysis sooner than 2 weeks after implantation ofthe peritoneal catheter (so-called break-in period) and ensure early inclusion of the patients inthe peritoneal dialysation programme (in particular diabetic patients).

Key words:
renal failure - treatment - peritoneal dialysis - peritoneal catheter - laparotomy laparoscopy.