Department of Surgery, Twin County Regional Healthcare, Galax, VA, USA.
Department of Surgery, Aspirus Iron River Hospital & Clinics, Iron River, MI, USA.
Am Surg. 2021 Jan;87(1):131-133. doi: 10.1177/0003134820945276. Epub 2020 Aug 28.
Peritoneal dialysis (PD) for rural patients with end-stage renal disease (ESRD) is convenient, efficient, and durable. However, patients with a history of previous abdominal surgeries or peritonitis are at an increased risk of PD malfunction. This case highlights the impact of securing the catheter to the abdominal wall laparoscopically to keep the PD catheter in an adhesion-free area to maintain patency and function in a patient with extensive intraperitoneal adhesions.
A 76-year-old white male was on PD which later was complicated with peritonitis and sepsis and subsequent catheter removal. A year later, the patient desired replacement of the PD catheter. Intraoperatively, diagnostic laparoscopy revealed significant intraperitoneal adhesions mainly located at the left side of the abdomen with the right side of the abdomen spared. The Tenckhoff PD catheter, which was straightened by a steel stylet, was inserted via a 5-mm trocar. The stylet was removed. The pig tail of the PD catheter was navigated away from the adhesion and directed to the right side of the abdomen for internal fixation. The catheter at 9 cm from the PD catheter cuff was attached to the right paramedian peritoneum.
PD started 1 week after placement. The patient had excellent inflow and outflow for 14 months to date without complication or need for revision.
The laparoscopic pexy of the PD catheter to the abdominal wall to keep the catheter in an adhesion-free compartment is beneficial in selected patients. A future study with a larger number of patients is needed to further validate this strategy.
对于农村终末期肾病（ESRD）患者来说，腹膜透析（PD）既方便又高效，且具有持久性。然而，有既往腹部手术或腹膜炎病史的患者，PD 发生故障的风险增加。本病例强调了通过腹腔镜将导管固定到腹壁上，将 PD 导管置于无粘连区域，以维持在广泛腹腔粘连患者中的通畅性和功能的重要性。
一名 76 岁白人男性接受 PD 治疗，后并发腹膜炎和脓毒症，继而导管被移除。一年后，患者希望更换 PD 导管。术中诊断性腹腔镜检查显示，大量的腹腔粘连主要位于腹部左侧，右侧腹部幸免。经 5mm 套管插入已由钢导丝拉直的 Tenckhoff PD 导管。移除导丝。PD 导管的猪尾部分避开粘连，导向右侧腹部进行内置固定。距 PD 导管袖口 9cm 处的导管固定于右侧腹膜中线。
置管后 1 周开始 PD。到目前为止，患者的 PD 流量良好，14 个月来无并发症，无需修订。
将 PD 导管腹腔镜固定到腹壁，将导管置于无粘连区域，对某些患者有益。需要进一步开展更大样本量的研究，以进一步验证该策略。
