COMPARATIVE EXPERIENCE OF A SIMPLE TECHNIQUE FOR LAPAROSCOPIC CHRONICAMBULATORY PERITONEAL-DIALYSIS CATHETER PLACEMENT

Background: Chronic ambulatory peritoneal dialysis (CAPD) is now an es tablished technique for renal dialysis. Patients with renal failure co pe poorly with major surgery and it is vital that the dialysis cathete r tip is sited accurately in the pelvis if long-term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy. Methods: A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2-year period. R esults of laparoscopically inserted catheters and those placed at lapa rotomy were compared. Results: Sixty catheters were inserted, 30 lapar oscopically and 30 at laparotomy. The mean operative time was 41 min i n the laparoscopic patients and 57 min in the laparotomy patients (P = 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P = 0.00002). There were three minor peri-operative complications in the l aparoscopic group and seven peri-operative complications in the laparo tomy group, three required reoperation and one resulted in the patient 's death. There were no significant differences in the incidence of ex it-site infection, catheter blockage, peritonitis, and overall cathete r survival, although the laparoscopically placed catheters had been fo llowed up for a shorter period (10 vs 16 months). Conclusions: This la paroscopic technique is safe and effective. Postoperative pain was les s than for open placement. Laparoscopically placed catheters had a low incidence of peri-operative complications. Medium-term patency is sim ilar to conventionally placed catheters. This procedure requires no ad ditional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.