Prophylactic laparoscopic omentopexy: a new technique for peritoneal dialysis catheter placement

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Abstract

Background: Prophylactic laparoscopic omentopexy is a safe technique to prevent catheter obstruction during peritoneal dialysis (PD). Here we described a technique through which the omentopexy was accomplished by Hem-o-loks before PD catheter insertion.

Methods: The procedures of omentopexy were described. To evaluate the efficiency of this surgical method, a retrospective review of PD catheter insertion cases and their follow-ups were performed, covering 10 consecutive patients with end-stage renal disease.

Results: All patients showed no intraoperative events. No catheter flow obstruction, migration, exit-site infection appeared during the follow-up.

Conclusion: Laparoscopic PD catheter insertion using omentopexy can decrease catheter obstruction and migration.

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Most cited references 19

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The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis.

Edward F Vonesh, J.O.N.J. Snyder, Robert N Foley … (2004)

While the survival ramifications of dialysis modality selection are still debated, it seems reasonable to postulate that outcome comparisons are not the same for all patients at all times. Trends in available data indicate the relative risk of death with hemodialysis (HD) compared to peritoneal dialysis (PD) varies by time on dialysis and the presence of various risk factors. This study was undertaken to identify key patient characteristics for which the risk of death differs by dialysis modality. Analyses utilized incidence data from 398,940 United States Medicare patients initiating dialysis between 1995 and 2000. Proportional hazards regression identified the presence of diabetes, age, and the presence of comorbidity as factors that significantly interact with treatment modality. Stratifying by these factors, proportional and nonproportional hazards models were used to estimate relative risks of death [RR (HD:PD)]. Of the 398,940 patients studied, 11.6% used PD as initial therapy, 45% had diabetes mellitus (DM), 51% were 65 years or older, and 55% had at least one comorbidity. Among the 178,693 (45%) patients with no baseline comorbidity, adjusted mortality rates in nondiabetic (non-DM) patients were significantly higher on HD than on PD [age 18-44: RR (95% CI) = 1.24 (1.07, 1.44); age 45-64: RR = 1.13 (1.02, 1.25); age 65+: RR = 1.13 (1.05, 1.21)]. Among diabetic (DM) patients with no comorbidity, HD was associated with a higher risk of death among younger patients [age 18-44: RR = 1.22(1.05, 1.42)] and a lower risk of death among older patients [age 45-64: RR = 0.92 (0.85, 1.00); age 65+: RR = 0.86 (0.79, 0.93)]. Within the group of 220,247 (55%) patients with baseline comorbidity, adjusted mortality rates were not different between HD and PD among non-DM patients [age 18-44: RR = 1.19 (0.94, 1.50); age 45-64: RR = 1.01 (0.92, 1.11); age 65+: RR = 0.96 (0.91, 1.01)] and younger DM patients [age 18-44: RR = 1.10 (0.92, 1.32)], but were lower with HD among older DM patients with baseline comorbidity [age 45-64: RR = 0.82 (0.77, 0.87); age 65+: RR = 0.80 (0.76, 0.85)]. Valid mortality comparisons between HD and PD require patient stratification according to major risk factors known to interact with treatment modality. Survival differences between HD and PD are not constant, but vary substantially according to the underlying cause of ESRD, age, and level of baseline comorbidity. These results may help identify technical advances that will improve outcomes of patients on dialysis.

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Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates.

P Copleston, S Fenton, Y. Mao … (1997)

Although kidney transplantation is the preferred treatment method for patients with ESRD, most patients are placed on dialysis either while awaiting transplantation or as their only therapy. The question of which dialytic method provides the best patient survival remains unresolved. Survival analyses comparing hemodialysis and continuous ambulatory peritoneal dialysis/continuous cyclic peritoneal dialysis (CAPD/CCPD), a newer and less costly dialytic modality, have yielded conflicting results. Using data obtained from the Canadian Organ Replacement Register, we compared mortality rates between hemodialysis and CAPD/CCPD among 11,970 ESRD patients who initiated treatment between 1990 and 1994 and were followed-up for a maximum of 5 years. Factors controlled for include age, primary renal diagnosis, center size, and predialysis comorbid conditions. The mortality rate ratio (RR) for CAPD/CCPD relative to hemodialysis, as estimated by Poisson regression, was 0.73 (95% confidence interval: 0.68 to 0.78). No such relationship was found when an intent-to-treat Cox regression model was fit. Decreased covariable-adjusted mortality for CAPD/CCPD held within all subgroups defined by age and diabetes status, although the RRs increased with age and diabetes prevalence. The increased mortality on hemodialysis compared with CAPD/CCPD was concentrated in the first 2 years of follow-up. Although continuous peritoneal dialysis was associated with significantly lower mortality rates relative to hemodialysis after adjusting for known prognostic factors, the potential impact of unmeasured patient characteristics must be considered. Notwithstanding, we present evidence that CAPD/CCPD, a newer and less costly method of renal replacement therapy, is not associated with increased mortality rates relative to hemodialysis.

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Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis.

Haya Rubin, Nancy Fink, Laura Plantinga … (2004)

In light of conflicting evidence of differential effects of dialysis modality on survival, patient experience becomes a more important consideration in choosing between hemodialysis and peritoneal dialysis. To compare patient satisfaction with hemodialysis and peritoneal dialysis in a cohort of patients who have recently begun dialysis. Cross-sectional survey at enrollment in a prospective inception cohort study of patients who recently started dialysis at 37 dialysis centers participating in the Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) study, a national multicenter study of dialysis outcomes, from October 1995 to June 1998. Of 736 enrolled incident dialysis patients, 656 (89%) returned a satisfaction questionnaire after an average of 7 weeks of dialysis. Data collected from a patient-administered questionnaire including 3 overall ratings and 20 items rating specific aspects of dialysis care. Patients receiving peritoneal dialysis were much more likely than those receiving hemodialysis to give excellent ratings of dialysis care overall (85% vs 56%, respectively; relative probability, 1.46 [95% confidence interval, 1.31-1.57]) and significantly more likely to give excellent ratings for each specific aspect of care rated. The 3 items with the greatest differences were in the domain of information provided (average of information items: peritoneal dialysis [69% excellent] vs hemodialysis [30% excellent]). The smallest differences were in ratings of accuracy of information from the nephrologist, response to pain, amount of fluid removed, and staff availability in an emergency. Adjustment for patient age, race, education, health status, marital status, employment status, distance from the center, and time since starting dialysis did not reduce the differences between peritoneal dialysis and hemodialysis patients. After several weeks of initiating dialysis, patients receiving peritoneal dialysis rated their care higher than those receiving hemodialysis. These findings indicate that clinicians should give patients more information about the option of peritoneal dialysis.

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Author and article information

Journal

Journal ID (nlm-ta): Ren Fail

Journal ID (iso-abbrev): Ren Fail

Journal ID (publisher-id): IRNF

Journal ID (publisher-id): irnf20

Title: Renal Failure

Publisher: Taylor & Francis

ISSN (Print): 0886-022X

ISSN (Electronic): 1525-6049

Publication date Collection: 2019

Publication date (Electronic): 26 March 2019

Volume: 41

Issue: 1

Pages: 113-117

Affiliations

[a ]Department of Nephrology, The First Affiliated Hospital of KangDa College of Nanjing Medical University, The First People's Hospital of Lianyungang , Lianyungang, China;

[b ]Department of Urology, The First Affiliated Hospital of KangDa College of Nanjing Medical University, The First People's Hospital of Lianyungang , Lianyungang, China;

[c ]Department of Haematology, The First Affiliated Hospital of KangDa College of Nanjing Medical University, The First People's Hospital of Lianyungang , Lianyungang, China

Author notes

[*]

Co-first authors of this study.

CONTACT Lei Zhang lygddm@ 123456163.com Department of Nephrology, The First Affiliated Hospital of KangDa College of Nanjing Medical University, The First People’s Hospital of Lianyungang , 6 Zhenghua East Road, Lianyun Gang, Lianyungang210029, China

Article

Publisher ID: 1583580

DOI: 10.1080/0886022X.2019.1583580

PMC ID: 6442096

PubMed ID: 30909767

SO-VID: df06b99c-db87-4b83-ab54-2525ee4b8199

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 23 October 2018

Date revision received : 11 February 2019

Date accepted : 11 February 2019

Page count

Figures: 4, Tables: 2, Pages: 5, Words: 2814

Funding

Funded by: Science and Technology Bureau Foundation of Lian Yungang

Award ID: ZD1407

This work was supported by grants from the Science and Technology Bureau Foundation of Lian Yungang [No. ZD1407].

Prophylactic laparoscopic omentopexy: a new technique for peritoneal dialysis catheter placement

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Abstract

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Karger: Nephrology

Most cited references 19

The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis.

Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates.

Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis.

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