Laparoscopic findings of peritoneal dialysis catheter malfunction and management outcomes.

ABSTRACT

OBJECTIVE: Peritoneal dialysis catheter malfunction is a common complication forcing conversion to hemodialysis. The purpose of this study was to evaluate laparoscopic findings of catheter malfunction and to establish a relationship between those findings and the outcomes of procedures performed. DESIGN: Retrospective study. SETTING: A tertiary referral center. PATIENTS 40 consecutive patients with stage 5 chronic kidney disease underwent 46 laparoscopic correction procedures for the treatment of peritoneal dialysis catheter malfunction between November 1994 and August 2004. MAIN OUTCOME MEASURES: Laparoscopic findings of catheter malfunction, procedures performed, catheter survival, and recurrent cases were evaluated. RESULTS: There were 28 tip migrations in 40 patients; 16 were without adhesions and 10 were associated with omental adhesions. Reposition and adhesiolysis were the most frequent procedures performed. Malfunction recurred in 12 patients and 5 of them underwent 6 secondary laparoscopic procedures. Estimated mean catheter survival was 19.9 +/-3.32 months (%95 confidence interval 13.43 - 26.46). CONCLUSIONS: The most frequent laparoscopic finding was catheter tip migration, with or without adhesions. Laparoscopic repositioning and adhesiolysis without omentectomy are simple and effective procedures that can prolong catheter survival, even in recurrent malfunctions.