Two plus one port laparoscopic assisted continuous ambulatory peritoneal dialysis insertion modified technique: a case series.

ABSTRACT

Continuous ambulatory peritoneal dialysis (CAPD) is one of the modalities for renal replacement therapy in patients with stage 5 chronic kidney disease. There are various techniques and modifications, but there is no main reference for laparoscopic catheter insertion. One common complication related to CAPD is the malposition of the Tenckhoff catheter. In this study, the authors present a modified laparoscopic technique for insertion that can prevent malposition of the Tenckhoff catheter by using two plus one port. Material and method: A retrospective case series from the medical records at Semarang Tertiary Hospital was identified between 2017 and 2021. Demographic, clinical, intraoperative, and postoperative complication data were collected with a 1-year follow-up after the CAPD procedure. Results: This study included 49 patients with a mean age of 43.2±13.6 years, and diabetes was the main cause (51.02%). This modified technique showed no complications intraoperatively. The postoperative complications were found to include one case of hematoma (2.04%), eight cases of omental adhesion (16.3%), seven cases of exit-site infection (14.28%), and two cases of peritonitis (4.08%). Malposition of the Tenckhoff catheter was not found 1-year after the procedure. Conclusion: The two plus one port modified laparoscopic assisted CAPD technique could prevent malposition of the Teckhoff catheter because it is already fixated in the pelvic. A long-term follow-up of 5 years is necessary to know the long-term survival of the Tenckhoff catheter in the next study.