Laparoscopic Placement of Oreopoulos–Zellerman Catheters in CAPD Patients

Abstract

Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease. Various techniques have been described for the insertion of peritoneal dialysis catheters. Lately, with the evolution of laparoscopic surgery, different laparoscopic techniques have also been presented, suggesting the technique is preferable to the open and percutaneous methods. To introduce and evaluate a new laparoscopic technique for insertion of Oreopoulos-Zellerman catheters in CAPD patients. The study was carried out in the First Department of Propaedeutic Surgery, Athens University Medical School, Hippokration Hospital. Between November 2000 and March 2002, the technique was applied in 20 consecutive patients (mean age 62 years, range 54 - 70 years) with end-stage renal disease. During this technique, a 10-mm trocar is placed just below the umbilicus for the optics and a 5-mm trocar is placed in the right lower quadrant. With the help of a 10-mm trocar, a tunnel is formed in the standard paramedian position on the left side, 2 - 3 cm below the plane of the umbilicus, for the insertion of the peritoneal catheter. A laparoscopic needle (GraNee needle; R-Med, Oregon, Ohio, USA) is used for the closure of the 10-mm trocar-induced peritoneal and fascia defect using a purse-string suture. The catheter is advanced into the abdomen under direct vision and guided toward the Douglas pouch. The subcutaneous tunnel and the patency test of the catheter are performed as the last main steps in our procedure. One surgeon undertook all procedures. All procedures were completed laparoscopically. The mean operative time was 30 minutes (range 25 - 40 minutes). There was no intraoperative complication or surgical mortality. One patient developed leakage at the catheter exit site 3 days after surgery; it was corrected under local anesthesia. During a mean follow-up time of 17 months (range 12 - 28 months), 1 patient required catheter removal due to fungal peritonitis. Laparoscopic insertion of the Oreopoulos-Zellerman catheter is a simple, quick, and safe method. We believe future experience will encourage the laparoscopic technique as the method of choice.