scholarly journals Neobladder creation is still a conduit to peritoneal dialysis – Successful use of peritoneal dialysis after invasive bladder cancer

2021 ◽  
pp. 089686082110658
Author(s):  
Alexandre Cosmatos ◽  
Brendan McCormick ◽  
Pierre Antoine Brown
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Surgery ◽  
Positive Impact ◽  
Cost Effective ◽  
Catheter Placement ◽  
Major Abdominal Surgery ◽  
Advanced Laparoscopy ◽  
History Of ◽  
Muscle Invasive ◽  
New Research

Peritoneal dialysis (PD) is as safe and more cost-effective than haemodialysis (HD). It also allows patients to undergo renal replacement therapy (RRT) from home. However, PD remains underutilised in many parts of the world. This is true in part because of many perceived relative contraindications to PD, including a history of prior major abdominal surgery. Prior major abdominal surgery is a concern for standard bedside or surgical catheter placement since these patients are at risk of having adhesions, which can complicate catheter placement. However, with laparoscopic advancements, prior major abdominal surgery is no longer even a relative contraindication to PD for skilled and experienced surgeons. We report the case of a male in his 70s with a history of cystoprostatectomy which was curative for a muscle invasive bladder carcinoma 5 years prior to his RRT. The patient had longstanding chronic kidney disease which worsened gradually. After receiving RRT education, the patient favoured PD. The catheter was placed despite the surgeon noting abdominal adhesions and the patient successfully underwent 12 months of PD which had a positive impact on his quality of life. He transferred to HD after contracting a complex PD-associated peritonitis. Thus, new research should be conducted to better understand the real impact of prior abdominal surgeries as a contraindication to PD, especially in centres where the surgeons have experience with advanced laparoscopy.

Outcome of Peritoneal Catheter Placement in the High-Risk Patient

1984 ◽  
Vol 4 (2_suppl) ◽  
pp. 112-114 ◽  
Author(s):  
A.S. Levey ◽  
G.M. Simon ◽  
J. McCauley ◽  
T.J. Smith ◽  
S. I. Cho ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Abdominal Surgery ◽  
High Risk Patient ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
Major Abdominal Surgery ◽  
Early Complications ◽  
Peritoneal Catheter ◽  
History Of

Serious early complications of catheter insertion and catheter outcomes are compared in patients with or without a history of major abdominal surgery or peritonitis. Previous major surgery and peritonitis are important risk factors for early serious complications of catheter placement. Despite the higher risk of early complications, subsequent attempts at catheter placement were successful in all but one of the high risk patients. Patients with previous major abdominal surgery or peritonitis generally are considered to be at high risk for complications of permanent peritoneal catheter placement. However, few physicians would refuse to attempt catheter insertion in patients highly motivated to undergo peritoneal dialysis. In this setting, the patient and the physician must decide whether the motivation and potential benefit justify the risk. Unfortunately, extensive quantitative data on the success rate and the likelihood of complications in the high-risk patient are not available. In order to determine the success rate and relative risk, we reviewed the outcome of catheter placement for continuous ambulatory peritoneal dialysis (CAPD) in our patients. In this report, we identify the serious early complications of catheter insertion and compare the outcomes in patients with and without a history of major abdominal surgery or peritonitis.

scholarly journals The Case for Laboratory Developed Procedures

2017 ◽  
Vol 4 ◽  
pp. 237428951770830 ◽  
Author(s):  
Karen L. Kaul ◽  
Linda M. Sabatini ◽  
Gregory J. Tsongalis ◽  
Angela M. Caliendo ◽  
Randall J. Olsen ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Laboratory ◽  
Positive Impact ◽  
Cost Effective ◽  
Effective Manner ◽  
History Of ◽  
Laboratory Procedures ◽  
Improvement Programs ◽  
Quality Improvement Programs ◽  
Clinical Laboratory Improvement Amendments

An explosion of knowledge and technology is revolutionizing medicine and patient care. Novel testing must be brought to the clinic with safety and accuracy, but also in a timely and cost-effective manner, so that patients can benefit and laboratories can offer testing consistent with current guidelines. Under the oversight provided by the Clinical Laboratory Improvement Amendments, laboratories have been able to develop and optimize laboratory procedures for use in-house. Quality improvement programs, interlaboratory comparisons, and the ability of laboratories to adjust assays as needed to improve results, utilize new sample types, or incorporate new mutations, information, or technologies are positive aspects of Clinical Laboratory Improvement Amendments oversight of laboratory-developed procedures. Laboratories have a long history of successful service to patients operating under Clinical Laboratory Improvement Amendments. A series of detailed clinical examples illustrating the quality and positive impact of laboratory-developed procedures on patient care is provided. These examples also demonstrate how Clinical Laboratory Improvement Amendments oversight ensures accurate, reliable, and reproducible testing in clinical laboratories.

The Effects of Previous Abdominal Operations and Intraperitoneal Adhesions on the Outcome of Peritoneal Dialysis Catheters

2010 ◽  
Vol 30 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Amir Keshvari ◽  
Mohammad Sadegh Fazeli ◽  
Alipasha Meysamie ◽  
Sepideh Seifi ◽  
Mohammad Kazem Nouri Taromloo
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Surgery ◽  
Previous History ◽  
Laparoscopic Approach ◽  
Surgical Revision ◽  
Intraperitoneal Adhesions ◽  
Previous Abdominal Surgery ◽  
Increased Risk ◽  
History Of ◽  
Abdominal Operations

BackgroundPatients with previous history of abdominal operations are sometimes excluded from consideration for peritoneal dialysis because of concerns for increased risk of complications during the implantation procedure and inadequate dialysis due to reduced peritoneal surface area. Employing a laparoscopic approach, we compared the outcome of peritoneal dialysis catheters in 2 groups of patients with and without intra-abdominal adhesions.MethodsAll data in this report were recorded prospectively. Revision-free and overall survival of catheters, the incidence of mechanical and infectious complication, and surgical revision rates were compared between the 2 groups.ResultsIn 217 successful catheter implantations, there was a history of previous abdominal surgery in 42.9% of procedures; only 26.9% of them had intraperitoneal adhesions; 2.8% of patients without history of previous abdominal surgery had intraperitoneal adhesions. There were no significant differences between the 2 groups for 1- and 2-year revision-free and overall catheter survival, mechanical dysfunction, infectious complications, or surgical revision rates.ConclusionHistory of previous abdominal surgery should not be used to judge the eligibility of patients for peritoneal dialysis. Laparoscopic placement is the best way to ensure optimal catheter outcomes equivalent to patients without previous abdominal surgery.

Successful Peritoneal Catheter Placement after Major Abdominal Surgery or Peritonitis

1986 ◽  
pp. 218-222 ◽  
Author(s):  
A. S. Levey ◽  
G. M. Simon ◽  
J. McCauley ◽  
T. J. Smith ◽  
S. I. Cho ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Catheter Placement ◽  
Major Abdominal Surgery ◽  
Peritoneal Catheter

scholarly journals Introduction of advanced laparoscopy for peritoneal dialysis catheter placement and the outcome in a University Hospital

2021 ◽  
Author(s):  
J. H. H. van Laanen ◽  
E. J. Litjens ◽  
M. Snoeijs ◽  
M. M. van Loon ◽  
A. G. Peppelenbosch
Keyword(s):  
Peritoneal Dialysis ◽  
Functional Outcome ◽  
Controlled Trial ◽  
Laparoscopic Group ◽  
Catheter Placement ◽  
University Hospital ◽  
Peritoneal Dialysis Catheter ◽  
Historical Cohort ◽  
Catheter Malfunction ◽  
Advanced Laparoscopy

Abstract Background Peritoneal dialysis (PD) catheters can be obstructed by omental wrapping or migration, leading to catheter malfunction. Multiple catheter placement techniques have been described. Advanced laparoscopy with fixation of the catheter and omentum has been reported to improve functional outcome compared to basic laparoscopy without fixation. This feasibility study describes surgical technique, complications, and comparison of the functional outcome of advanced versus basic laparoscopic catheter placement. Methods Between July 2016 and April 2019, the advanced laparoscopy technique was applied in all eligible patients. Two experienced surgeons placed the catheters in a standardized procedure. Peri-operative complications and functional outcome of the catheter were scored. Results were compared to a historical cohort retrieved from our RCT performed earlier using basic laparoscopy. Findings The basic laparoscopic group (BLG) consisted of 46 patients and the advanced laparoscopic group (ALG) of 32. Complication rate in both groups was similar and low with 7% in the BLG and 6% in the ALG (p = 1.0). There was a trend toward better functional catheter outcome in the ALG (88%) compared to the BLG (70%) (p = 0.1). Part of the catheter failures in the ALG could be related to the learning curve. After revision surgery, 94% of patients in the ALG had a functional catheter. These findings lead to the set-up of a multi-center randomized-controlled trial, currently running, comparing basic to advanced laparoscopic techniques.

scholarly journals Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum

2015 ◽  
Vol 35 (5) ◽  
pp. 576-585 ◽  
Author(s):  
Samar Medani ◽  
Wael Hussein ◽  
Mohamed Shantier ◽  
Robert Flynn ◽  
Catherine Wall ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Surgery ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Catheter Survival ◽  
Significant Difference ◽  
History Of ◽  
First Time

BackgroundThe percutaneous Seldinger method of peritoneal dialysis catheter (PDC) insertion has gained favor over recent years whereas traditionally it was reserved for patients considered not fit for general anesthesia. This blind technique is believed to be less safe, and is hence avoided in patients with previous laparotomy incisions. Reports on the success of this method may therefore be criticized for selection bias. In those with no prior abdominal surgery the optimal method of insertion has not been established.MethodsWe retrospectively reviewed the outcomes of first-time PDC placements comparing the percutaneous (group P) and surgical (group S) insertion techniques in patients without a history of previous abdominal surgery in a single center between January 2003 and June 2010. We assessed catheter survival at 3 and 12 months post-insertion and compared complication rates between the two groups.ResultsA total of 63 percutaneous and 64 surgical catheter insertions were analyzed. No significant difference was noted in catheter survival rates between group P and group S (86.2% vs 80% at 3 months, p = 0.37; and 78.3% vs 71.2% at 12 months, p = 0.42 respectively). Early and overall peritonitis rates were similar (5% vs 5.3%; p = 1, and 3.5 vs 4.9 episodes per 100 patient-months; p = 0.13 for group P and group S respectively). There were also no significant differences between the two groups in exit site leaks (15.9% in group P vs 6.3% in group S; p = 0.15), poor initial drainage (9.5% in group P vs 10.9% in group S, p = 0.34) or secondary drainage failure (7.9% in group P vs 18.8% in group S, p = 0.09).ConclusionThis study illustrates the success and safety of percutaneous PDC insertion compared with the open surgical technique in PD naive patients without a history of prior abdominal surgery. Catheter survival was favorable with percutaneous insertion in this low-risk patient population but larger prospective studies may help to determine whether either method is superior. The percutaneous technique can be recommended as a minimally invasive, cost-effective procedure that facilitates implementing an integrated care model in nephrology practice.

scholarly journals Videolaparoscopic Catheter Placement Reduces Contraindications to Peritoneal Dialysis

2013 ◽  
Vol 33 (4) ◽  
pp. 372-378 ◽  
Author(s):  
Stefano Santarelli ◽  
Matthias Zeiler ◽  
Tania Monteburini ◽  
Rosa Maria Agostinelli ◽  
Rita Marinelli ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Surgery ◽  
Surgical Procedures ◽  
Reference Method ◽  
Catheter Placement ◽  
Laparoscopy Group ◽  
Number Of Patients ◽  
Laparotomy Group ◽  
To Receive

BackgroundVideolaparoscopy is considered the reference method for peritoneal catheter placement in patients with previous abdominal surgery. The placement procedure is usually performed with at least two access sites: one for the catheter and the second for the laparoscope. Here, we describe a new one-port laparoscopic procedure that uses only one abdominal access site in patients not eligible for laparotomic catheter placement.MethodWe carried out one-port laparoscopic placement in 21 patients presenting contraindications to blind surgical procedures because of prior abdominal surgery. This technique consists in the creation of a single mini-laparotomy access through which laparoscopic procedures and placement are performed. The catheter, rectified by an introducer, is inserted inside the port. Subsequently, the port is removed, leaving the catheter in pelvic position. The port is reintroduced laterally to the catheter, confirming or correcting its position. Laparotomic placement was performed in a contemporary group of 32 patients without contraindications to blind placement. Complications and long-term catheter outcome in the two groups were evaluated.ResultsAdditional interventions during placement were necessary in 12 patients of the laparoscopy group compared with 5 patients of the laparotomy group ( p = 0.002). Laparoscopy documented adhesions in 13 patients, with need for adhesiolysis in 6 patients. Each group had 1 intra-operative complication: leakage in the laparoscopy group, and intestinal perforation in the laparotomy group. During the 2-year follow-up period, laparoscopic revisions had to be performed in 6 patients of the laparoscopy group and in 5 patients of the laparotomy group ( p = 0.26). The 1-year catheter survival was similar in both groups. Laparoscopy increased by 40% the number of patients eligible to receive peritoneal dialysis.ConclusionsVideolaparoscopy placement in patients not eligible for blind surgical procedures seems to be equivalent to laparotomic placement with regard to complications and long-term catheter outcome. The number of patients able to receive peritoneal dialysis is substantially increased.

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