Laparoscopic Placement of Peritoneal Dialysis Catheter

A. The Condition. You may have renal failure, and need some form of dialysis. One form of dialysis involves irrigating your abdominal cavity with fluid (peritoneal dialysis). This procedure places a catheter into your abdomen so that you can undergo peritoneal dialysis.

B. Symptoms. You may have symptoms of renal failure, which would include:

• Weakness
• Poor appetite
• Confusion
• Low urine production

C. Laparoscopic Placement of Peritoneal Dialysis Catheter. The surgeon will make about 2-3 small incisions in your abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen. This process allows the surgeon to see inside of your abdomen more easily. A laparoscope is inserted through another port. The laparoscope looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to place the peritoneal dialysis catheter into your abdominal cavity. The catheter will exit out of your skin. After the catheter has been placed, the carbon dioxide is released out of the abdomen through the slits, and then these sites are closed with sutures or staples, or covered with glue-like bandage and steri-strips.

D. Nonsurgical Treatment. Sometimes a peritoneal dialysis catheter can be placed under local anesthesia, without putting carbon dioxide in the abdomen. Your doctor will discuss with you what your best option is.

E. Risks. The primary risks of laparoscopic placement of peritoneal dialysis catheter are:

• Infection of the skin at one of the small ports sites
• Perforation of the small bowel
• Collection of pus inside your abdomen (intraabdominal abscess)
• Postoperative ileus (the intestines slow down/stop working for several days)
• Small bowel obstruction (kinking, twisting, or scarring which blocks the bowel)

F. Expectations

1. Before Your Operation. Laparoscopic placement of peritoneal dialysis catheter usually is an elective procedure. The preoperative evaluation might include blood work and a urinalysis. If you smoke, then you should stop immediately. If you are taking blood thinners (for example, aspirin, coumadin, Lovenox, or Plavix), then you will need to stop these one week prior to your procedure. Your surgeon and anesthesia provider will review your health history, medications (including blood thinners), and options for pain control.

2. Your Recovery. You usually can go home in 1 or 2 days after a laparoscopic placement of peritoneal dialysis catheter. Your doctor and/or nurses will instruct you on the use of your catheter. You will be given medication for pain. You should limit your activity to light lifting (no more than 15 lb) for one month.

3. Call Your Surgeon if you have one or more of the following:

• Severe pain
• High fever
• Odor or increased drainage from your incision
• No bowel movements for three days
• Nausea, vomiting, and/or crampy abdominal pain

Pertinent References

Haggerty, SP, Zeni TM, Carder M, Frantzides, CT; Laparoscopic Peritoneal Dialysis Catheter Insertion Using a Quinton Percutaneous Insertion Kit. J Soc Laparoendosc Surg. 11: 208-214, 2007