Ondokuz Mayıs University, Samsun, Turkey.
Pediatr Surg Int. 2024 May 9;40(1):128. doi: 10.1007/s00383-024-05702-3.
Continuous ambulatory peritoneal dialysis is an important modality of renal replacement therapy in children. Catheter dysfunction (commonly obstruction) is a major cause of morbidity and is a significant concern that hampers renal replacement therapy. As omentum is a significant cause of obstruction, some recommend routine omentectomy during insertion of the peritoneal dialysis catheter. Omentopexy rather than omentectomy has been described in adults to spare the omentum as it may be needed as a spare part in many conditions. Laparoscopic approach is commonly preferred as it provides global evaluation of the peritoneal space, proper location of the catheteral end in the pelvis and lesser morbidity due to inherent minimally invasive nature.
The aim of this study is to present the technique of laparoscopic peritoneal dialysis catheter placement in children with concurrent omentopexy.
We retrospectively evaluated our patients who underwent laparoscopic placement of peritoneal dialysis catheter with concomitant omentopexy or omentectomy.
A total of 30 patients were enrolled who received either omentectomy (n = 18) or omentopexy (n = 12). Four catheters were lost in the omentopexy group (33%) and 3 in the omentectomy group (17%), but none were related to omental obstruction. Three out of 4 patients in the omentopexy group and 2 out of 3 patients in the omentectomy group had a previous abdominal operation as a potential cause of catheter loss. Previous history of abdominal surgery was present in 6 patients (50%) in the omentopexy group and 3 patients (17%) in the omentectomy group.
As omentum was associated with catheter failure, omentectomy is commonly recommended. Alternatively, omentopexy can be preferred in children to spare an organ that may potentially be necessary for many surgical reconstructive procedures in the future. Laparoscopic peritoneal dialysis catheter placement with concomitant omentopexy appears as a feasable and reproducible technique. Although the catheter loss seems to be higher in the omentopexy group, none was related with the omentopexy procedure and may be related to the higher rate of history of previous abdominal operations in this group.
持续非卧床腹膜透析是儿童肾脏替代治疗的重要方式。导管功能障碍（通常为阻塞）是发病率的主要原因，也是阻碍肾脏替代治疗的重要关注点。由于网膜是阻塞的一个重要原因，一些人建议在插入腹膜透析导管时常规进行网膜切除术。在成人中，已经描述了网膜固定术而不是网膜切除术，以保留网膜，因为在许多情况下，网膜可能需要作为备用部件。腹腔镜方法通常是首选的，因为它可以提供腹膜空间的全面评估、导管末端在骨盆中的适当位置以及由于固有微创性质而导致的较少发病率。
本研究旨在介绍儿童腹腔镜腹膜透析导管置管术同时行网膜固定术的技术。
我们回顾性评估了接受腹腔镜腹膜透析导管置管术同时行网膜切除术或网膜固定术的患者。
共纳入 30 例患者，其中 18 例接受网膜切除术，12 例接受网膜固定术。网膜固定组有 4 根导管丢失（33%），网膜切除术组有 3 根导管丢失（17%），但均与网膜阻塞无关。网膜固定组 4 例患者中有 3 例、网膜切除术组 3 例患者中有 2 例患者之前有腹部手术史，这可能是导管丢失的原因。网膜固定组有 6 例患者（50%）和网膜切除术组有 3 例患者（17%）有腹部手术史。
由于网膜与导管失败有关，因此通常建议进行网膜切除术。或者，为了保留可能在未来许多外科重建手术中需要的器官，也可以在儿童中选择网膜固定术。腹腔镜腹膜透析导管置管术同时行网膜固定术似乎是一种可行且可重复的技术。尽管网膜固定组的导管丢失似乎更高，但没有与网膜固定术相关，可能与该组中既往腹部手术史的发生率较高有关。
