The placement of Tenckhoff peritoneal dialysis catheter by laparoscopic approach - our experience

Ambulatory peritoneal dialysis is an alternative to haemo dialysis for patients with End Stage Renal Disease (ESRD). This study evaluates our experience in laparoscopic placement of Tenckhoff Catheter (TC) for peritoneal dialysis. Methods: Between december 2000 and december 2007 in the 11 Surgical Clinic of Timisoara the laparoscopic implantation of the Tenckhoff catheter was performed in a lot of 56 patients with ESRD with mean age 53.04 years (limit between 17-80 years). In this lot of patients 66 laparoscopic. procedures were performed - 58 catheter implantation, 2 catheter changing, 2 repositioning, 2 adhesiolysis and 2 withdrawn. Mean operative time was 47.3 min. (limits 35-90 min.). Results: Immediate functionality ratio (< 30 days) was 98.11% of cases. The immediate postoperatives complications were: leakage of dialysis solution in three patients (5.35% of cases), bleeding from the incision in three patients (5.35% of cases) and one patient (1.78% of cases) with a migration of the TC, case who required replacement of the catheter performed also by laparoscopy. The late postoperatives complications were: obstruction with omentum of the catheter in two patients (3.57% of cases), massive leakage in one patient (1.78% of cases), migration of the TC in one patient (1.78% of cases), tunnel infection in one patient (1.78% of cases) and peritonitis in two patients (3.57% of cases). In all these patients laparoscopical replacement of the catheter was required. The minor complications were: exit site infection in 3 patients (5.35% of cases), tunnel infection in 7 patients (12.5 % of cases), incisional hernia in one patient and pleural effusiom in one patients (1.78% of cases). Conclusions: Laparoscopic placement of TC is a successful method compared to other procedures. The great advantage is the direct visualization and fixation of the TC in the pelvis.