Use of Laparoscopic Surgery or Guide Wire Directed Manipulation under Fluoroscopy in the Management of Malfunctioning Peritoneal Dialysis Catheters

Kim, Hee Jin; Kim, Tae Hyung; Lee, Tae Won; Lim, Chun Gyoo; Kim, Myung Jae

Abstract

BACKGROUNDS: The peritoneal catheter is the continuous ambu1atary peritoneal dialysis (CAPD) patients lifeline. Over the years, Obstruction or displacement of the chronic dialysis catheter have been a common complication of peritoneal dialysis (PD), Laparoscopic surgery or guide wire directed manipulation under fluoroscopy have been developed to manage outflow obstruction. We describes our retrospective experience with laparoscopic surgery or fluoro-scopically controlled guide wire manipulation, including catheter outcome to determine the ultimate benefit of these procedures.
MATERIALS AND METHODS
During the period from June 1996 to May 1999, 182 Tenckhoff double-cuff peritoneal catheter were inserted. Approximately 86Yo of the catheters were inserted by nephrologist using the Y-TEC system and 14% by laparoscopic implantation. 21 (11.5%) were manipulated. 11 (52%) were initially performed with guide wire under fluoroscopic control. The remaining 10 manipulations were performed by laparoscopic surgery. A successful outcome was defined as normal peritoneal catheter function at thirty days.
RESULTS
Among the catheters manipulated, 16 (76%) were inserted by nephrologist and 5 (24%) inserted by surgeons. The time elapsed between catheter insertion and manipulation varied between one day and thirty-two days with a mean of nine days. The primary etiology of dysfunction was catheter displacement in fourteen, and omental wrapping with adhesions in the remaining 7 cases. Thirty-day catheter function was achieved in 52% of initially catheter manipulations with guide wire under fluoroscapic control (40%) or laparoscopic surgery (60%) and 100% of subsequently laparoscopic manipulations following initially guide wire under fluoroscopy, with an overall success rate of 15 of 21 (71.4%). There were no significant complications.
CONCLUSION
Malfunctioning CAPD catheters can successfully be restored to a usable state by the combination laparoscopic surgery and fluoroscopically guide wire manipulations.