Attard Joseph A, Attard Alexander
Department of Surgery, St. James's Hospital, Borg Olivier Street, Sliema SLM 1807, Malta.
Case Rep Surg. 2014;2014:492567. doi: 10.1155/2014/492567. Epub 2014 Jul 8.
Introduction. Laparotomy in patients on peritoneal dialysis (PD) is associated with an increased risk of morbidity. Furthermore, standard protocol recommends removal of the PD catheter when surgery on the intestine is required. As far as we are aware, this is the first case report of laparoscopic right hemicolectomy in a patient on automated PD where the PD catheter was left in situ. Case Report. A 61-year-old man man on APD who presented with a caecal carcinoma was stabilised on temporary haemodialysis (HD) prior to undergoing a laparoscopic right hemicolectomy without removal of the PD catheter. He made an uneventful recovery and APD was resumed successfully 2 weeks after surgery. Discussion. PD patients undergoing intra-abdominal surgery are at increased risk of complications. While the benefits of laparoscopic surgery in the standard surgical population are well established, there is limited experience of the technique in PD patients. Possible advantages could theoretically be early resumption of PD as well as less PD failure due to the formation of adhesions. Conclusion. Our experience with this case indicates that laparoscopic right hemicolectomy in a background of PD can be undertaken without removal of the PD catheter and is associated with early resumption of PD.
引言。腹膜透析(PD)患者进行剖腹手术会增加发病风险。此外,标准方案建议在需要进行肠道手术时拔除PD导管。据我们所知,这是首例在接受自动腹膜透析的患者中进行腹腔镜右半结肠切除术且保留PD导管的病例报告。病例报告。一名61岁接受自动腹膜透析的男性患者,因盲肠癌就诊,在接受腹腔镜右半结肠切除术且未拔除PD导管之前,先通过临时血液透析(HD)使其病情稳定。他术后恢复顺利,术后2周成功恢复自动腹膜透析。讨论。接受腹部手术的腹膜透析患者并发症风险增加。虽然腹腔镜手术在普通外科患者中的益处已得到充分证实,但在腹膜透析患者中该技术的经验有限。理论上,可能的优势包括能早期恢复腹膜透析以及因粘连形成导致的腹膜透析失败较少。结论。我们对该病例的经验表明,在腹膜透析背景下进行腹腔镜右半结肠切除术时可不拔除PD导管,且与早期恢复腹膜透析相关。