Department of General Surgery, Seth GS Medical College & KEM Hospital, Mumbai, 400012, India.
Surg Endosc. 2023 Aug;37(8):6491-6494. doi: 10.1007/s00464-023-10154-2. Epub 2023 May 31.
Peritoneal dialysis is a life sustaining renal replacement therapy for patients with end stage renal disease. In comparison to hemodialysis it offers better mobility and independence to patients. A number of techniques including open, laparoscopic and fluoroscopy guided, and their modifications, have been described for intraperitoneal catheter insertion. We describe our technique and results of laparoscopic peritoneal dialysis (PD) catheter insertion at a tertiary care centre in India.
48 patients were referred from the department of nephrology at our centre for laparoscopic PD catheter insertion. A two port technique was used in 37 patients and three port technique was implemented in the rest for simultaneous adhesiolysis and/or omentectomy. A straight tip catheter was tunneled through the rectus muscle in all patients. Two patients had incisional hernia from a previous abdominal surgery which was repaired concomitantly with onlay meshplasty.
The operative time ranged between 20 and 35 min under general anaesthesia. Three patients were subjected to urgent start dialysis of which one patient developed peridrain leak as an early complication which was managed conservatively. All other patients were commenced on peritoneal dialysis two weeks after surgery. There was no other surgical site occurrence or episodes of peritonitis reported in a 6 month follow up period with the department of nephrology.
In the era of minimal access surgery, the laparoscopic approach is feasible for widespread and safe use for PD catheter insertion. The benefits of PD can thus be made available to patients at civil hospitals even with a basic laparoscopy setup.
腹膜透析是一种维持终末期肾病患者生命的肾脏替代疗法。与血液透析相比，它为患者提供了更好的移动性和独立性。已经描述了许多技术，包括开放、腹腔镜和透视引导，以及它们的修改，用于腹膜内导管插入。我们描述了我们在印度一家三级护理中心进行腹腔镜腹膜透析（PD）导管插入的技术和结果。
48 名患者从我们中心的肾病科转来接受腹腔镜 PD 导管插入术。37 名患者采用双端口技术，其余患者采用三端口技术同时进行粘连松解和/或网膜切除术。所有患者均将直型尖端导管经腹直肌隧道。两名患者因以前的腹部手术有切口疝，在同时行腹壁修补和网片修补术。
全麻下手术时间在 20 至 35 分钟之间。有 3 名患者需要紧急开始透析，其中 1 名患者发生早期引流管渗漏，经保守治疗后得到控制。所有其他患者在手术后两周开始腹膜透析。在与肾病科进行的 6 个月随访期间，没有发生其他手术部位并发症或腹膜炎发作。
在微创外科时代，腹腔镜方法对于 PD 导管插入术的广泛和安全应用是可行的。因此，即使在基本的腹腔镜设备下，腹膜透析的好处也可以提供给公立医院的患者。
