Extraperitoneal placement of Tenckhoff catheters: a cause of immediate malfunction

Secure Placement of Continuous Ambulatory Peritoneal Dialysis Catheters under Laparoscopic Assistance

Laparoscopic surgical procedures were performed in 18 patients with end-stage renal disease for the placement of a Tenckhoff peritoneal dialysis catheter. Among them, 6 patients had received previous lower abdominal surgical treatment and 3 patients underwent laparoscopic rescue of dysfunctional Tenckhoff catheters. The operating time was between 40 and 80 minutes (median, 50 minutes). After a median follow-up period of 11 months, the short-term results revealed that no significant morbidity was associated with this procedure, and all catheters except two functioned well postoperatively. One of the catheters was not functional because of the patient's death, and the other one was removed because of persistent peritonitis. Laparoscopic secure placement of continuous ambulatory peritoneal dialysis catheters appears to be a simple, safe, and viable procedure, even in patients with previous lower-abdominal operations. The same technique can be used to rescue dysfunctional catheters that are displaced or obstructed by adhesion and omental wrapping, thus increasing catheter longevity.

Laparoscopic salvage of Tenckhoff catheters

Laparoscopic abdominal surgery has opened many previously unexploited diagnostic and therapeutic options. At our institution, we have used laparoscopic techniques in several patients to successfully salvage dysfunctional Tenckhoff catheters. Peritoneal dialysis has gained widespread approval as an acceptable alternative to hemodialysis. Unfortunately, following surgical placement of the catheter, mechanical complications are all too common and usually result in unnecessary removal or replacement. To illustrate the usefulness of laparoscopy in preventing this unnecessary patient morbidity, we present a case study of an easily correctable cause of Tenckhoff catheter outflow obstruction that would have avoided detection under normal circumstances.