Modified Single Port Laparoscopic Peritoneal Dialysis Catheter Insertion - Initial Experience and Outcome from a Tertiary Care Centre

Abstract

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are emerging as a major health related issues in developing countries. The increasing numbers require rapid adaptation of existing health-care policies. The number of patients requiring renal care is only bound to increase in coming years with the increasing incidence and prevalence of diabetes. Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is performed on end-stage renal disease (ESRD) patients. There is abundant literature regarding post-operative outcomes and re-operative rates following CAPD. We report our initial experience of modified single port laparoscopic technique of placing CAPD catheters using a single port through the Palmer’s point and discuss our surgical outcomes. Methods: This was a retrospective review (2019-2020) of patients undergoing CAPD catheter placement at SMVD Narayana Superspecialty Hospital. Outcome analysis focused on patient related outcomes, including early (< 30 days) versus late (≥ 30 days) complication and re-operation rates. Results: A total of 30 patients with ESRD, (mean ASA score = 3.3) were included in the study who underwent modified single port laparoscopic (n = 30) CAPD catheter placement (mean follow-up = 180 days). The total complication rate with the procedure was 43%, with re-operation rate of 20%. CAPD catheter non-function occurred in 06 patients (20% of total). CAPD catheter migrations occurred in 03 patients (10% of total). CAPD catheter related infections occurred in 05 patients (16% of total), and 02 required re-operation; 03 patients were treated successfully with culture directed antibiotics. There were 2 deaths during the study period, one due to peritonitis and other due to underlying cardiac disease. There was no surgical mortality in the study group. Conclusion: Although CAPD catheter placement in patients with ESRD are technically un-complicated to accomplish, long term results suggest as many as one in three patients will struggle with some form of catheter malfunction or infection. Our modified technique and the results have led to changes in our CAPD catheter placement technique, as well as the post-operative patient care algorithm.