Laparoscopic-Assisted Abdominal Wall Pexy of Peritoneal Dialysis Catheter

Intraperitoneal Adhesions ◽

Number Of Patients ◽

Increased Risk ◽

The Right ◽

Stage Renal Disease ◽

Background Peritoneal dialysis (PD) for rural patients with end-stage renal disease (ESRD) is convenient, efficient, and durable. However, patients with a history of previous abdominal surgeries or peritonitis are at an increased risk of PD malfunction. This case highlights the impact of securing the catheter to the abdominal wall laparoscopically to keep the PD catheter in an adhesion-free area to maintain patency and function in a patient with extensive intraperitoneal adhesions. Subject A 76-year-old white male was on PD which later was complicated with peritonitis and sepsis and subsequent catheter removal. A year later, the patient desired replacement of the PD catheter. Intraoperatively, diagnostic laparoscopy revealed significant intraperitoneal adhesions mainly located at the left side of the abdomen with the right side of the abdomen spared. The Tenckhoff PD catheter, which was straightened by a steel stylet, was inserted via a 5-mm trocar. The stylet was removed. The pig tail of the PD catheter was navigated away from the adhesion and directed to the right side of the abdomen for internal fixation. The catheter at 9 cm from the PD catheter cuff was attached to the right paramedian peritoneum. Results PD started 1 week after placement. The patient had excellent inflow and outflow for 14 months to date without complication or need for revision. Conclusion The laparoscopic pexy of the PD catheter to the abdominal wall to keep the catheter in an adhesion-free compartment is beneficial in selected patients. A future study with a larger number of patients is needed to further validate this strategy.

An Unusual Case of Recurrent Migration of the Peritoneal Dialysis Catheter into the Inguinal Hernia Sac

Case Reports in Nephrology and Dialysis ◽

10.1159/000515566 ◽

2021 ◽

pp. 152-157

Author(s):

Haruna Fukuzaki ◽

Junichiro Nakata ◽

Yuka Shirotani ◽

Yuki Shimizu ◽

Masayuki Maiguma ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Inguinal Hernia ◽

Hernia Sac ◽

First Case ◽

Catheter Tip ◽

Hernia Inguinal ◽

The Right ◽

Stage Renal Disease ◽

We herein report the first case of a patient with recurrent migration of the peritoneal dialysis (PD) catheter into the inguinal hernia sac. A 58-year-old man suffered from end-stage renal disease due to polycystic kidney disease (PKD). A year before starting PD, a PD catheter was implanted with stepwise initiation of PD using the Moncrief-Popovich technique. He complained of drain failure and right inguinal swelling during the induction period and was diagnosed with right inguinal hernia. Further examination revealed that the PD catheter tip had migrated into the inguinal hernia sac. Although surgery was planned, the PD catheter tip spontaneously migrated back into the intra-peritoneal space. 14 months later, he noticed fill and drain failure again. Diagnosis was PD catheter dysfunction due to migration into the right inguinal hernia sac. PD was resumed without issues after repositioning of the PD catheter and repair of the inguinal hernia. Inguinal hernia is a frequent complication in PD patients, especially in those with PKD. Early diagnosis and treatment of hernia should be considered in PD patients.

Is Nighttime Really Not the Right Time for a Laparoscopic Cholecystectomy?

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/6076948 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Anna C. M. Geraedts ◽

Meindert N. Sosef ◽

Jan Willem M. Greve ◽

Mechteld C. de Jong

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Morbidity ◽

Time Of Day ◽

Outcome Data ◽

Emergency Procedure ◽

Out Of Hours ◽

Increased Risk ◽

The Right ◽

The Impact ◽

Univariate Analyses

Purpose. The impact of an out-of-hours laparoscopic cholecystectomy on outcome is controversial. We sought to determine the association between an out-of-hours procedure and postoperative complications within 90 days. Methods. Between 2014 and 2016, 1553 laparoscopic cholecystectomies were performed. Therapeutic, operative, and outcome data were prospectively collected and analyzed. We defined out of hours as during weekends, national holidays, and daily between 5PM and 8AM. Results. Most patients operated on were female (n=988; 63.6%) and the majority of procedures were electives (n=1341; 86.3%). Although all procedures were performed with a laparoscopic intent, 42 (2.7%) were converted to open procedure. In total, 145 (9.3%) procedures were out of hours, all nonelective, and in most cases for acute cholecystitis (n=111; 7.1%). Overall, there were 212 complications in 191 patients (12.3%), most (n=153; 9.9%) classified as minor. The conversion rate in the out-of-hours group was significantly higher (9.7% vs 2.0%; p<0.001). While univariate analyses revealed out-of-hours procedure (OR=1.83; p=0.008) to be associated with an increased risk of complications, when controlling for confounding factors by multivariate analysis, this association was not found. However, operation by surgical staff (OR=1.71) and conversion to laparotomy (OR=3.74) were found to be independently associated with an increased risk of complications (both p<0.05), while an emergency procedure tended to be associated with postoperative morbidity (OR=1.82; p=0.069). Conclusion. An out-of-hours laparoscopic cholecystectomy was not found to be an independent risk factor for developing postoperative morbidity and time of day should therefore only be a relative contraindication.

The impact of postoperative percent change of parathormone level from baseline value on the rate of hypocalcemia after total thyroidectomy

International Surgery ◽

10.9738/intsurg-d-16-00249.1 ◽

2017 ◽

Author(s):

Ismail Cem Sormaz ◽

Ahmet Yalin Iscan ◽

Ilker Ozgur ◽

Seyma Karakus ◽

Fatih Tunca ◽

...

Keyword(s):

Total Thyroidectomy ◽

Albumin Concentration ◽

Postoperative Hypocalcemia ◽

Percent Change ◽

Number Of Patients ◽

Increased Risk ◽

Symptomatic Hypocalcemia ◽

Postoperative Serum ◽

Group 2 ◽

Background: To investigate the impact of the percent change of postoperative parathormone (PoPTH) level from baseline value (∆PTH) on the rate of hypocalcemia after total thyroidectomy. Methods: Assays of serum PTH and calcium (Ca) were performed preoperatively and at 24 hours postoperatively in 222 consecutive patients who underwent total thyroidectomy. Postoperative hypocalcemia was defined as serum calcium level corrected for albumin concentration (cCa) <8.5mg/dl. Patients with postoperative hypocalcemia were classified as group1 (n=100) and those with normal Ca levels as group 2 (n=122). The PoPTH levels and ∆PTH were compared between the two groups. ROC analysis was performed to determine the cut off values for PoPTH and ∆PTH. Results: The mean PoPTH level was significantly lower in group 1 compared to group 2 (18.6±15.3 pg/ml vs 32.3±15.6 pg/ml, respectively; P<0.0001). PoPTH values were within normal range in 54% of the patients with hypocalcemia and 35% of those with symptomatic hypocalcemia. PoPTH <28pg/ml or ∆PTH >45 were significantly associated with increased risk of post-thyroidectomy hypocalcemia (P=0.0001). A ∆PTH >70% ,PoPTH ≤ 15.5pg/ml and postoperative serum cCa concentrations<8.0mg/dl significantly predicted symptomatic hypocalcemia(P=0.009;P=0.006;andP=0.0001;respevtively).The sensitivities of ∆PTH,PoPTH level and postoperative serum cCa concentration to predict symptomatic hypocalcemia were 67%,64% and100, respectively. Conclusion: Although, PTH decline significantly correlate with symptomatic hypocalcemia, a considerable number of patients may experience hypocalcemic symptoms in spite of normal PoPTH levels. Analysis of serum Ca concentrations at 24 hours postoperatively help to achieve a more precise prediction of patients who bear a high risk for developing hypocalcemic symptoms.

Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

Blood Purification ◽

10.1159/000441580 ◽

2015 ◽

Vol 40 (4) ◽

pp. 320-325 ◽

Cited By ~ 16

Author(s):

Agnes Shin-Man Choy ◽

Philip Kam-Tao Li

Keyword(s):

Hong Kong ◽

Peritoneal Dialysis ◽

Financial Burden ◽

Training Programme ◽

Number Of Patients ◽

Ultrafiltration Failure ◽

Average Annual Cost ◽

The Government ◽

Stage Renal Disease ◽

In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.

Efficiency and safety of using a peritoneal dialysis catheter weighted with a stainless steel ballast : the Limousin experience

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v2i4.23873 ◽

2019 ◽

Vol 2 (4) ◽

pp. 193-200

Author(s):

Bénédicte Larivière-Durgueil ◽

Rémi Boudet ◽

Marie Essig ◽

Stéphane Bouvier ◽

Ali Abdeh ◽

...

Keyword(s):

Stainless Steel ◽

Peritoneal Dialysis ◽

Infectious Complications ◽

Control Group ◽

Causal Factors ◽

Catheter Migration ◽

Mechanical Complications ◽

Increased Risk ◽

One Year

Objective: To assess the recurrence of PD catheter migration after the introduction of a walnut ballast. Materials and Methods: Retrospective study from 1999 to 2014 of PD patients followed in Limousin. Were compared two groups: ballast group (patients who benefited from the establishment of stainless steel ballast at the intraperitoneal catheter extremity) with 26 patients and control group with 204 patients. The primary endpoint was the occurrence of an episode catheter’s migration after ballast’s establishment. Secondary objectives were (i) to determine the causal factors leading to the catheter weighting, (ii) to ensure the safety of the procedure on the following criteria: infectious complications, mechanicals complications, epurations criteria, and catheter’s survival. Results: More than one year after the implementation of the ballast, no recurrent migration was observed in 86.6% of cases. It wasn’t found an increased risk of infections (OR = 0.5, 95% CI [0.22, 1.13]) or mechanical complications (OR = 1.77- 95% CI [0.77, 4.05]) between the two groups. The adequation criteria were similar: KT / V total : 2.37 in the control group and 2.28 in the ballast group (p = 0.63). The survival of the ballast catheter was comparable among the two groups (p = 0.983). Three causal factors that led to the ballast were identified: automated peritoneal dialysis (APD) (OR = 0.38, 95% CI [0.16, 0.9]), the failure from the first use of the catheter (OR = 19.48, CI 95 % [7.67, 49.48]) and the incarceration of the omentum (OR = 15.84, 95% CI [5.81, 43.21]). Conclusion: The ballast used in these study appears to prevent recurrence of migration, without any impact in terms of infectious or mechanical complications, or on the dialysis criteria or on catheter’s survival. However this catheter does currently not have an EC authorization

Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium

Peritoneal Dialysis International ◽

10.1177/089686088000100504 ◽

1980 ◽

Vol 1 (5) ◽

pp. 54-58 ◽

Cited By ~ 10

Author(s):

Norbert H. Lameire ◽

Marc De Paepe ◽

Raymond Vanholder ◽

Johan Verbanck ◽

Severin Ringoir

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Average Rate ◽

Sodium Concentration ◽

Risk Category ◽

Diabetic Patients ◽

Serum Triglycerides ◽

Number Of Patients ◽

Stage Renal Disease ◽

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country. The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications. Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases. The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs. After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment. At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.

Breaking the bottle neck to enhance pediatrics renal transplantation at Soba university hospital: Role of a non-governmental organization

Healthcare in Low-resource Settings ◽

10.4081/hls.2019.7930 ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Ihab B. Abdalrahman ◽

Shaima N. Elgenaid ◽

Rashid Ellidir ◽

Asma Nizar Mohammed Osman Abdallah ◽

Safa Ahmed Hassan Hamid ◽

...

Keyword(s):

Renal Transplant ◽

Quality Care ◽

Healthcare Delivery ◽

University Hospital ◽

Healthcare Delivery System ◽

Governmental Organization ◽

Low Resource ◽

Number Of Patients ◽

Stage Renal Disease ◽

High cost and limited resources of pediatrics renal transplant in low-resource countries limits the number of transplants. However, the collaboration between government and community sector provided high quality care for these patients. Here we highlight the impact of a non-governmental organization in facilitating pediatrics renal transplant. Data was collected from files of all pediatric patients withend stage renal disease who received renal transplant between January 2010 and December 2017 at Soba University Hospital (77 patients). The 8-year period was divided into 16 intervals of 6 months each. The number of patients who received renal transplant ranged from 1 to 12 patients in each interval. There was a rise in 2017 when 21 (28.7%) patients received kidney transplant. In the last 6 months in 2017 there was a significant reduction in duration of hospital stay compared to the rest of the period; it dropped from 16.36 to 9.92 days (P=0.003). Partnership between governmental and non-governmental sectors is a good strategy in low resource area to bridge some of the gaps of healthcare delivery system.

Peritoneal Microbiome in End-Stage Renal Disease Patients and the Impact of Peritoneal Dialysis Therapy

Microorganisms ◽

10.3390/microorganisms8020173 ◽

2020 ◽

Vol 8 (2) ◽

pp. 173

Author(s):

Liliana Simões-Silva ◽

Ricardo Araujo ◽

Manuel Pestana ◽

Isabel Soares-Silva ◽

Benedita Sampaio-Maia

Keyword(s):

Peritoneal Dialysis ◽

Human Microbiome ◽

Cross Sectional Study ◽

Cross Sectional ◽

Peritoneal Tissue ◽

Stage Renal Disease ◽

End Stage ◽

Factors influencing the occurrence of peritoneal dialysis (PD)-related infections are still far from fully understood. Recent studies described the existence of specific microbiomes in body sites previously considered microbiome-free, unravelling new microbial pathways in the human body. In the present study, we analyzed the peritoneum of end-stage kidney disease (ESKD) patients to determine if they harbored a specific microbiome and if it is altered in patients on PD therapy. We conducted a cross-sectional study where the peritoneal microbiomes from ESKD patients with intact peritoneal cavities (ESKD non-PD, n = 11) and ESKD patients undergoing PD therapy (ESKD PD, n = 9) were analyzed with a 16S rRNA approach. Peritoneal tissue of ESKD patients contained characteristically low-abundance microbiomes dominated by Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes. Patients undergoing PD therapy presented lower species richness, with dominance by the Pseudomonadaceae and Prevotelaceae families. This study provides the first characterization of the peritoneal microbiome in ESKD patients, bringing new insight to the human microbiome. Additionally, PD therapy may induce changes in this unique microbiome. The clinical relevance of these observations should be further explored to uncover the role of the peritoneal microbiome as a key element in the onset or aggravation of infection in ESKD patients, especially those undergoing PD.

The Impact of Spinopelvic Mobility on Arthroplasty: Implications for Hip and Spine Surgeons

Journal of Clinical Medicine ◽

10.3390/jcm9082569 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2569 ◽

Cited By ~ 1

Author(s):

Henryk Haffer ◽

Dominik Adl Amini ◽

Carsten Perka ◽

Matthias Pumberger

Keyword(s):

Lumbar Lordosis ◽

Flexion Contracture ◽

Sacral Slope ◽

Eos Imaging ◽

Appropriate Treatment ◽

Number Of Patients ◽

Increased Risk ◽

Sagittal Spinal Balance ◽

Hip Flexion ◽

Spinopelvic mobility represents the complex interaction of hip, pelvis, and spine. Understanding this interaction is relevant for both arthroplasty and spine surgeons, as a predicted increasing number of patients will suffer from hip and spinal pathologies simultaneously. We conducted a comprehensive literature review, defined the nomenclature, summarized the various classifications of spinopelvic mobility, and outlined the corresponding treatment algorithms. In addition, we developed a step-by-step workup for spinopelvic mobility and total hip arthroplasty (THA). Normal spinopelvic mobility changes from standing to sitting; the hip flexes, and the posterior pelvic tilt increases with a concomitant increase in acetabular anteversion and decreasing lumbar lordosis. Most classifications are based on a division of spinopelvic mobility based on ΔSS (sacral slope) into stiff, normal, and hypermobile, and a categorization of the sagittal spinal balance regarding pelvic incidence (PI) and lumbar lordosis (LL) mismatch (PI–LL = ± 10° balanced versus PI–LL > 10° unbalanced) and corresponding adjustment of the acetabular component implantation. When performing THA, patients with suspected pathologic spinopelvic mobility should be identified by medical history and examination, and a radiological evaluation (a.p. pelvis standing and lateral femur to L1 or C7 (if EOS (EOS imaging, Paris, France) is available), respectively, for standing and sitting radiographs) of spinopelvic parameters should be conducted in order to classify the patient and determine the appropriate treatment strategy. Spine surgeons, before planned spinal fusion in the presence of osteoarthritis of the hip, should consider a hip flexion contracture and inform the patient of an increased risk of complications with existing or planned THA.

A disposable, ultra-fine endoscope for non-invasive, close examination of the intraluminal surface of the peritoneal dialysis catheter and peritoneal cavity

Scientific Reports ◽

10.1038/s41598-020-74129-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Masaaki Nakayama ◽

Chieko Hamada ◽

Keitaro Yokoyama ◽

Yudo Tanno ◽

Nanae Matsuo ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Clinical Study ◽

Peritoneal Cavity ◽

Abdominal Cavity ◽

Peritoneal Membrane ◽

Non Invasive ◽

Luminal Side ◽

Stage Renal Disease ◽

Abstract The ability to visualize intraluminal surface of peritoneal dialysis (PD) catheter and peritoneal cavity could allow elucidation of the cases of outflow problems, and provide information on changes to the peritoneal membrane leading to encapsulating peritoneal sclerosis. A non-invasive examination that allows those monitoring in need is desirable. We have developed a disposable ultra-fine endoscope that can be inserted into the lumen of the existing PD catheter, allowing observation of the luminal side of the catheter and peritoneal cavity from the tip of the PD catheter, with minimum invasion in practice. In a pre-clinical study in pigs and a clinical study in 10 PD patients, the device provided detailed images, enabling safe, easy observation of the intraluminal side of the entire catheter, and of the morphology and status of the peritoneal surface in the abdominal cavity under dwelling PD solution. Since this device can be used repeatedly during PD therapy, clinical application of this device could contribute to improved management of clinical issues in current PD therapy, positioning PD as a safer, more reliable treatment modality for end-stage renal disease.