Daniswara Nanda, Yudha Fajar G P, Santosa Ardy, Soedarso Moh A, Nugroho Eriawan A, Wibisono Dimas S, Addin Sofyan R
Department of Surgery, Urology Division.
General Practicioner, Faculty of Medicine Diponegoro University, Kariadi General Hospital, Semarang, Indonesia.
Ann Med Surg (Lond). 2023 Apr 6;85(5):1390-1394. doi: 10.1097/MS9.0000000000000307. eCollection 2023 May.
Continuous ambulatory peritoneal dialysis (CAPD) is one of the modalities for renal replacement therapy in patients with stage 5 chronic kidney disease. There are various techniques and modifications, but there is no main reference for laparoscopic catheter insertion. One common complication related to CAPD is the malposition of the Tenckhoff catheter. In this study, the authors present a modified laparoscopic technique for insertion that can prevent malposition of the Tenckhoff catheter by using two plus one port.
A retrospective case series from the medical records at Semarang Tertiary Hospital was identified between 2017 and 2021. Demographic, clinical, intraoperative, and postoperative complication data were collected with a 1-year follow-up after the CAPD procedure.
This study included 49 patients with a mean age of 43.2±13.6 years, and diabetes was the main cause (51.02%). This modified technique showed no complications intraoperatively. The postoperative complications were found to include one case of hematoma (2.04%), eight cases of omental adhesion (16.3%), seven cases of exit-site infection (14.28%), and two cases of peritonitis (4.08%). Malposition of the Tenckhoff catheter was not found 1-year after the procedure.
The two plus one port modified laparoscopic assisted CAPD technique could prevent malposition of the Teckhoff catheter because it is already fixated in the pelvic. A long-term follow-up of 5 years is necessary to know the long-term survival of the Tenckhoff catheter in the next study.
持续性非卧床腹膜透析（CAPD）是终末期慢性肾脏病患者肾脏替代治疗的方式之一。存在多种技术及改良方法，但腹腔镜置管尚无主要参考标准。与CAPD相关的一种常见并发症是Tenckhoff导管位置不当。在本研究中，作者介绍了一种改良的腹腔镜置管技术，通过使用两加一穿刺口可预防Tenckhoff导管位置不当。
回顾性分析三宝垄三级医院2017年至2021年的病历。收集人口统计学、临床、术中及术后并发症数据，并在CAPD手术后进行1年随访。
本研究纳入49例患者，平均年龄43.2±13.6岁，主要病因是糖尿病（51.02%）。这种改良技术术中无并发症。术后并发症包括1例血肿（2.04%）、8例网膜粘连（16.3%）、7例出口处感染（14.28%）和2例腹膜炎（4.08%）。术后1年未发现Tenckhoff导管位置不当。
两加一穿刺口改良腹腔镜辅助CAPD技术可预防Teckhoff导管位置不当，因为其已固定于盆腔。下一项研究需要进行5年的长期随访以了解Tenckhoff导管的长期存活情况。
