Laparoscopic insertion of Peritoneal Dialysis Catheters in children - The new gold standard?

Abstract

PURPOSE To assess the effectiveness, complication rates and their management using the minimally invasive approach of placing peritoneal dialysis catheters (PDC) in children from an experience of six consecutive years. MATERIAL AND METHODS This is an ongoing prospective study conducted for the last six years from 2002. Children with established renal failure requiring insertion of PDC were included. The insertions were performed by or under the supervision of a single consultant surgeon using the laparoscopic technique. Partial omentectomy was performed and the catheter accurately placed in the pelvis under vision via a single camera port and seldinger technique. The catheter could then be used immediately as required in the post-operative period. This method is approved by the National institute of clinical excellence (NICE, UK) quoting no increased morbidity in children. RESULTS Forty six children with a mean age of 9 years (1.0 – 17.5) had 48 PDC inserted laparoscopically between 2002 and 2007. Mean time for insertion was 27 mins (23 – 33). 18 catheters were used for dialysis within 24 hours. Early complications - a minor leak resolved within 24 hours, 3 exit site infections treated successfully, 1 bloclage due to fibrin clot resolved with urokinase. 2 catheters were removed due to infections and replaced after treating the infection. 4 catheters blocked two weeks post operatively; 3 of them were successfully repaired laparoscopically using an additional 5 mm port to release adhesions. In one case the laparoscope was used to diagnose the problem of a severe inflammatory reaction and the catheter was removed. We have not performed any case of open PDC insertion. CONCLUSIONS Laparoscopic single port insertion of PDC allows quick, accurate and safe placement of the catheter under vision, immediate use with minimum morbidity and good cosmesis. Laparoscopy allows relook, salvage or revision and deserves to be the gold standard.