Videolaparoscopy with Partial Omentectomy in Patients on Peritoneal Dialysis

Editar: Slow and inadequate drainage is common in peritoneal dialysis (PD) and may occur shortly after peritoneal catheter insertion or later in the course of dialysis. Poor outflow may be due to extrinsic pressure from adjacent organs or omental wrapping. Catheter tip migration is another important cause of poor drainage. Irrespective of the position, refractory catheter migration requires catheter replacement. Two-way obstruction may be due to fibrin or blood clots within the catheter. Forcibly flushing the catheter with heparinized saline, the classical use of fibrinolytics, or mechanical intervention may resolve the obstruction. If this fails, repair by laparotomy is necessary. In recent years laparoscopic surgery (LS) has found a wider use in surgery. Some authors (1-5) have suggested LS for peritoneal catheter placement in patients with previous abdominal surgeries and malfunctioning PD catheter repositioning. In the case of catheter migration, in order to avoid re-occurrence, anchorage of the catheter to theperitoneum by suture stitches using various methods has been suggested (2,6-8), or partial omentectomy during the operation for the catheter replacement in videolaparoscopy may be effective (8). We have used LS to salvage peritoneal catheters malfunctioning due to one-way obstruction caused by omental wrapping and two-way obstruction caused by fibrin and blood clots. Since 1993,4 patients on CAPD and 2 patients on cont inuous cycling peritoneal dialysis ( 4 males and 2 females, average age 66 years, range 45 -82 years), have undergone LS 7 to 60 days after peritoneal catheter placement. The procedure was performed under general anesthesia. In 4 patients, peritoneal cathe ter obstruction was due to omental wrapping with the catheter tip positioned in the right upper abdomen; the catheter was set free from the omental adhesions and repositioned into the pelvis. In 3 patients, partial omentectomy was performed using suitable forceps in laparoscopy, and in 1 patient omentectomy was performed through a smalllaparoscopic incision. In 2 other patients, peritoneal catheter obstruc tion was due to fibrin and blood clots; a saline irriga tion allowed us to reset the catheter function. All patients received antibiotic prophylaxis and PD was restarted (break-in) after 2 weeks in 4 patients, whereas in 2 patients, the peritoneal treatment was continued by cycler with low exchange volumes (50