Laparoscopic omentectomy for peritoneal dialysis catheter flow obstruction: A case report and review of the literature

Peritoneal dialysis catheter outflow dysfunction frequently is caused by om entum or epiploic appendices blocking the side holes of the catheter tubing . Laparoscopy has been utilized increasingly to remedy mechanical blockage of the peritoneal device. This obviates the need for catheter replacement, permits early return to dialysis, and lowers the patient dropout rate from peritoneal dialysis as a modality for renal replacement therapy. We report a case of laparoscopic subtotal omentectomy to successfully resolve recurre nt catheter obstruction that failed previous omentolysis and omentopexy. Us ing four port sites, the omental resection was accomplished using the harmo nic scalpel. The procedure was performed on an ambulatory basis, dialysis w as resumed after 1 week, and there were no infectious complications or port site leaks. We define terminology to standardize reporting of omentectomy. Our technique of laparoscopic omentectomy is described and compared to tho se of previously published reports. The role of laparoscopic omentectomy re lative to other commonly used laparoscopic approaches to the obstructed per itoneal dialysis catheter is reviewed.