Outcomes of Laparoscopic and Open CAPD Catheter Placement: A Single-Center Experience

Abstract

Background: Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement is typically a straightforward surgical procedure performed on chronically ill patients with end-stage renal disease (ESRD). Post-operative outcomes and reoperative rates vary greatly in the medical literature. We report our experience using both minimally invasive and open techniques in placing CAPD catheters and offer our surgical outcomes. Methods: This study is an IRB-approved, retrospective review (2005-2018) of all patients undergoing CAPD catheter placement at Mayo Clinic-Rochester. Analysis focused on specific patient outcomes, including early ( 30 days) complication and reoperation rates. Results: A total of 173 patients with ESRD (mean ASA score =3.1) underwent laparoscopic (n=22) and open (n=151) CAPD catheter placement (mean follow-up = 309 days; range: 1-3497 days). The total index operation complication rate was 41%. The total index reoperation rate was 37%and was similar in open and laparoscopic approaches. CAPD catheters malfunctioned in 19patients (11% of total) and each underwent reoperation. CAPD catheter infections occurred in30 patients (17% of total), and 24 required reoperation; 6 patients were treated successfully with antibiotics. CAPD catheter migrations occurred in 21 patients (12% of total) and all underwent reoperation. Conclusion: Although CAPD catheter placements in patients with ESRD are technically easy to accomplish, the long term outcomes suggest as many as one in three patients will struggle with catheter function or infection. This study has led to changes in our technical CAPD catheter placement procedures, as well as the post-operative patient care algorithm.