Laparoscopic placement of the Tenckhoff catheter for peritoneal dialysis

Continuous ambulatory peritoneal dialysis catheters can be inserted by open laparotomy as well as by laparoscopy. A prospective randomized study was s cheduled to investigate the results of the laparoscopic versus open laparot omy technique for placement of continuous ambulatory peritoneal dialysis ca theters. Fifty patients were enrolled and randomly allocated into two group s of 25 patients each. Group A underwent continuous ambulatory peritoneal d ialysis catheter placement via the open laparotomy technique. In 22 patient s, catheters were inserted via midline incision, and in 3 patients with his tories of previous catheterization, a paramedian incision was used. Continu ous ambulatory peritoneal dialysis was started 24 to 48 hours later. Group B underwent laparoscopic placement of the catheter with fixation into the p elvis and suture closure of the port wounds. In 21 patients. this catheter placement was the first such placement, and in 4 patients, a previous cathe ter had been inserted by the open technique and removed for dysfunction. Co ntinuous ambulatory peritoneal dialysis was started at the end of the proce dure. The mean operative time was 22 minutes in group A and 29 minutes in g roup B (P < 0.001), Fluid leakage was observed in eight patients in group A , but in no patients in group B (P < 0.005). Peritonitis occurred in Five p atients in group A and in three patients in group B (P > 0.1), Tip migratio n occurred in five patients in group A and no patients in group B (P < 0.00 5), In group B, two patients underwent a simultaneous cholecystectomy and o ne underwent incisional hernia repair. Laparoscopic placement of a Tenckhof f catheter leads to better function than does thr open procedure; it allows immediate start of dialysis without fluid leakage and permits simultaneous performance of other laparoscopic procedures.