Efficacy of Laparoscopic Peritoneal Dialysis Catheter Placement in Children

Abstract

Purpose

: The mechanical failure of peritoneal dialysis catheters (PDC) in children often results from catheter malposition or occlusion. We evaluated the efficacy of laparoscopic placement or revision of peritoneal dialysis catheters (LPDC) in children.

Patients and Methods

: Between 1996 and 1999, LPDC placement (N = 6) or revision (N = 4) was performed in 10 children with a mean age of 9 ± 2 years (range 4 days-18 years). Nine patients also underwent omentectomy. Demographics and functional outcomes were reviewed.

Results

: One inguinal hernia identified during laparoscopy was repaired during the same anesthesia. Seven PDC have functioned without revision for 17 ± 5 months (range 10-22 months). Two PDC functioned without revision until removed after renal transplantation at 12 and 15 months. One catheter malfunctioned at 4 days, necessitating laparoscopic revision, and thereafter functioned until removal after transplantation at 6 months. Overall, the revision-free catheter survival rate was 90% at 6, 12, and 18 months. One patient developed port site hernias and underwent repair without catheter revision.

Conclusions

: Early experience with LPDC placement or revision suggests this method can reduce mechanical failures associated with other techniques reported in the literature. Furthermore, LPDC permits identification of comorbid conditions that may be corrected at the time of PDC placement.