Minilaparotomy for malfunctioning peritoneal dialysis catheter by nephrologists: experiences at two centers

Abstract

Catheter malfunction is one of the most important complications of peritoneal dialysis (PD). We have performed minilaparotomy for catheter repair by nephrologists. This study aimed to evaluate the effectiveness and safety of the surgery. The surgery was performed 11 times on 10 PD patients with catheter malfunction (3 man, 7 women; mean age 54.3 ± 14.6 years; 4 diabetes, 3 glomerulonephritis, 3 other) at two hospitals. All patients had inflow and/or outflow obstruction. One patient had inserted the PD catheter using conventional surgical technique, and the remaining nine patients had used Moncrief-Popovich technique. Seven patients with catheters embedded using the Moncrief-Popovich technique showed catheter occlusion at the time of externalization. The remaining three patients experienced catheter obstruction 6.0 ± 2.9 months after commencing PD. The cause of obstruction was fibrin in six patients, wrapping by fimbriae of the fallopian tube in two patients, omentum wrapping in two patients. One patient had no blockage in the catheter. Operative time was 97 ± 46 min, and no intraoperative complications were observed. PD was interrupted for 5.9 ± 3.0 days and was resumed without leakage in all patients. However, catheter malfunction recurred in one patient 3 months after the surgery. The mean hospital stay was 22.4 ± 14.7 days. Minilaparotomy by nephrologists is a safety and suitable for the management of catheter malfunction. In addition, it is necessary to always consider the possibility that the catheter has been occluded at the time of externalization in the Moncrief-Popovich technique.