Comprehensive abdominal surgery for treating refractory peritoneal dialysis-associated peritonitis: a major technical modification

BACKGROUND: As laparoscopic surgery for peritoneal dialysis-associated peritonitis progressed, our focus shifted to changing the surgical strategy and improving the procedural details. The treatment of refractory peritonitis has become increasingly prominent within the surgeon's scope. Comprehensive treatment of refractory peritoneal dialysis-associated peritonitis (PDAP) remains a challenge in nephrology and has attracted continuous innovation and technological advancements. Comprehensive treatment of refractory peritoneal dialysis-associated peritonitis, especially surgical intervention, has also become an important breakthrough direction for our center to improve the quality of life and prognosis of patients with end-stage renal disease. METHODS: The study included control and experimental groups comprising patients who underwent laparoscopic surgery between January 2017 and December 2019 and patients who underwent laparoscopic surgery with technical modifications between January 2020 and December 2022, respectively. RESULTS: The experimental group (9.34 +/- 15.74 ng/mL) demonstrated a notably significant mean decrease in procalcitonin pre- and post- surgery compared to the control group (1.62 +/- 4.59 ng/mL). The mean difference between preoperative and postoperative C-reactive protein in the experimental group (46.35 +/- 74.64 mg/L) was higher than in the control group (7.75 +/- 91.72 mg/L). The duration of postoperative gas expulsion and postoperative hospital stay in the experimental group (54.60 +/- 32.62 h, 18.72 +/- 11.20 d) was significantly shorter than in the control group (83.96 +/- 41.84 h, 33.14 +/- 18.96 d). CONCLUSIONS: Thus, minimally invasive laparoscopic treatment is a core component of a novel strategy that is necessary and effective for the comprehensive treatment of refractory PDAP. Our research focus has gradually shifted from the minimally invasive treatment for simple peritonitis, or peritoneal dialysis tube blockage, towards the innovation of comprehensive treatment strategies centered on surgical intervention for refractory peritonitis.