Laparoscopic mesenterioadhesiotomy and Tenckhoff catheter placement in patients with predisposing abdominal surgery.

Abstract

Peritoneoscopic surgery has been performed widely for a variety of abdominal surgical diseases. We describe here a safe and reliable technique of laparoscopic-assisted mesenterioadhesiotomy and peritoneal Tenckhoff catheter placement in patients who have previously undergone abdominal surgery. Five patients suffering from end-stage renal failure previously underwent single and/or polyabdominal surgery. The surgical procedures included hysterectomy, ovarian resection, appendectomy, and transabdominal right nephrectomy. Under general endotrachial anesthesia, a laparoscope was placed down through a direct cut made using a trocar. After CO2 gas insufflation, another one or two trocars were put in place for surgical procedures. To avoid intestinal injury, mesenterioadhesiotomy was performed carefully using a high-frequency hook electrode, forceps, and scissors forceps, and the Tenckhoff catheter was subsequently inserted with forceps directly into Douglas' fossa. Peritoneal equilibration tests performed 30-70 days after the initiation of continuous ambulatory peritoneal dialysis (CAPD) treatment revealed moderate to good peritoneal effectiveness. This procedure permits the surgeon to perform safe and exact catheter placement into Douglas' fossa even when there is a possibility that peritoneal and mesenterial adhesion are present. We believe that this technique of catheter placement may extend the indication for CAPD treatment in patients with predisposing lower abdominal surgery.