Comparative Study of Laparoscopic and Open Insertion of Peritoneal Dialysis Catheter

Abstract

Background: Laparoscopic insertion of Tenckhoff catheters has gained wider acceptance and is performed in many centres. This paper compares the immediate as well as the long-term results of catheters inserted by open and laparoscopic technique.

Methods: The operative techniques were described. Retrospective case notes audit of all patients who had peritoneal dialysis catheter inserted at The Queen Elizabeth Hospital during the last 10 years was performed to compare the operative morbidity and long term complications.

Results: Eight-two Tenckhoff catheters were placed in 77 patients. Forty-one catheters were inserted in 37 patients with open technique and 41 catheters in 40 patients with laparoscopic technique. Mean follow up period was 536 days in laparoscopic group and 777 days in open group. The patients in laparoscopic group had shorter operative time (38 min vs. 48 min), less postoperative narcotic requirement (2.6 mg. vs. 17 mg. of morphine or equivalent), earlier resumption of regular diet (1 day vs. 2.8 days) and shorter post operative hospital stay (3.6 days vs. 8.2 days). With laparoscopic technique, there was 10 per cent incidence of obstruction and 7.5 per cent incidence of leakage (5.2% and 2.6% respectively in open group). In the long-term follow up, the catheter survival was comparable in both groups.

Conclusion: Laparoscopic technique provides advantages over open technique in reducing post operative pain, hastening post operative recovery and shortening the hospital stay. The benefits of laparoscopic technique are in the immediate postoperative period.