Impact of Prior Abdominal Procedures on Peritoneal Dialysis Catheter Outcomes: Findings From the North American Peritoneal Dialysis Catheter Registry

RATIONALE & OBJECTIVE

A history of prior abdominal procedures may influence the likelihood of referral for peritoneal dialysis (PD) catheter insertion. To guide clinical decision making in this population, this study examined the association between prior abdominal procedures and outcomes in patients undergoing PD catheter insertion.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

Adults undergoing their first PD catheter insertion between November 1, 2011 and November 1, 2020, at 11 institutions in Canada and the US participating in the International Society for Peritoneal Dialysis (ISPD) North American Catheter Registry.

EXPOSURE

Prior abdominal procedure(s), defined as any procedure that enters the peritoneal cavity.

OUTCOMES

Primary outcome: time to the first of abandonment of the PD catheter, or interruption/termination of PD.

SECONDARY OUTCOMES

rates of emergency room visits, hospitalizations, and procedures.

ANALYTICAL APPROACH

Cumulative incidence curves were used to describe the risk over time and an adjusted Cox proportional hazards model was used to estimate the association between the exposure and primary outcome. Models for count data were used to estimate the associations between the exposure and secondary outcomes.

RESULTS

A total of 855 patients met the inclusion criteria. Thirty-one percent had a history of a prior abdominal procedure and 20% experienced at least one PD catheter-related complication that led to the primary outcome. Prior abdominal procedures were not associated with an increased risk of the primary outcome [Adjusted HR 1.12 (95% CI 0.68-1.84)]. Upper abdominal procedures were associated with a higher adjusted hazard of the primary outcome, but there was no dose-response relationship concerning the number of procedures. There was no association between prior abdominal procedures and other secondary outcomes.

LIMITATIONS

Observational study and cohort limited to sample of patients felt to be potential candidates for PD catheter insertion.

CONCLUSION

A history of prior abdominal procedure(s) does not appear to influence catheter outcomes following PD catheter insertion. Such a history should not be a contraindication to peritoneal dialysis.

The Influence of Prior Abdominal Surgery on Robot-Assisted Partial Nephrectomy

Background

We evaluated the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy in initial Japanese series.

Methods

We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery based on perioperative outcomes. The chi-square test and Mann-Whitney U test were used for statistical analyses of variables.

Results

Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58%) had no prior abdominal surgery, whereas 66 patients (42%) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (80.4%) had prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, P = 0.031). No significant difference was observed in the conversion rate between the two groups (P = 0.556).

Conclusion

Robot-assisted partial nephrectomy appears to be a safe approach for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery.

Impact of prior abdominal surgery on postoperative prolonged ileus after ileostomy repair

BACKGROUND AND AIMS

Postoperative ileus (POI) is one of the most common reasons for sustained hospital stays after ileostomy repair. Although many factors have been investigated as POI risk factors, the investigation of the impact of prior abdominal surgery (PAS) before rectal cancer surgery has been limited. This study aimed to identify the impact of PAS as a risk factor for POI after ileostomy repair.

MATERIAL AND METHODS

A total of 220 consecutive patients with rectal cancer who underwent ileostomy repair were enrolled. The patients were divided into PAS-positive and PAS-negative groups according to the history of PAS before rectal cancer surgery. Univariate and multivariate analyses were performed to identify the clinicopathological factors associated with POI.

RESULTS

The PAS-positive group had a longer operation time (111 min vs. 93.4 min, p=0.029) and a greater length of hospital stay (10 days vs. 7.8 days, p=0.003) compared with the PAS-negative group. POI was more frequent in the PAS-positive group (23.1% vs. 6.2%, p=0.011). The POI rate in the entire cohort was 8.1%. The repair method (stapled side-to-side vs. hand-sewn end-to-end, odds ratio OR=3.6, 95% confidence interval CI=1.2-11.1, p=0.022) and PAS (odds ratio=4.0, 95% confidence interval=1.2-12.8, p=0.017) were significant predictors of POI in the multivariate analysis.

CONCLUSIONS

This study suggests that PAS before rectal cancer surgery is associated with POI after ileostomy repair.

Multicentre outcomes of robot-assisted partial nephrectomy after major open abdominal surgery

OBJECTIVE

To evaluate the outcomes of robot-assisted partial nephrectomy RAPN after major prior abdominal surgery (PAS) using a large multicentre database.

PATIENTS AND METHODS

We identified 1 686 RAPN from five academic centres between 2006 and 2014. In all, 216 patients had previously undergone major PAS, defined as having an open upper midline/ipsilateral incision. Perioperative outcomes were compared with those 1 470 patients who had had no major PAS. The chi-squared test and Mann-Whitney U-test were used for categorical and continuous variables, respectively.

RESULTS

There was no statistically significant difference in Charlson comorbidity index, tumour size, R.E.N.A.L. nephrometry score or preoperative estimated glomerular filtration rate (eGFR) between the groups. Age and body mass index were higher in patients with PAS. The PAS group had a higher estimated blood loss (EBL) but this did not lead to a higher transfusion rate. A retroperitoneal approach was used more often in patients with major PAS (11.2 vs 5.4%), although this group did not have a higher percentage of posterior tumours (38.8 vs 43.3%, P = 0.286). Operative time, warm ischaemia time, length of stay, positive surgical margin, percentage change in eGFR, and perioperative complications were not significantly different between the groups.

CONCLUSIONS

RAPN in patients with major PAS is safe and feasible, with increased EBL but no increased rate of transfusion. Patients with major PAS had almost twice the likelihood of having a retroperitoneal approach.