Endoscopic surgery for peritoneal dialysis catheters in children

Abstract

The first reports of the use of peritoneal dialysis (PD) to treat children with renal failure were published in the late 1940s (Bloxum and Powell 1948; Swan and Gordon 1949). During the 1950s disposable nylon catheters and commercially prepared dialysis solutions became available. Thus, PD became more practical for the short-term treatment of acute renal failure (ARF). Treatment of chronic renal failure (CRF) with PD was unsuccessful until reliable peritoneal access was developed in the late 1960s. A "permanent" PD catheter was introduced by Palmer et al. in 1964, and was later modified and developed by Tenckhoff and Schecter in 1968. The second catheter is still in use today. The proportion of the children treated with PD increased after two new innovations in PD: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD), which were described in 1976 and 1981 respectively (Diaz-Buxo et al. 1981; Moncrief et al. 1978; Popovich et al. 1976). Basically there are three methods for PD catheter placement: 1. Blind percutaneous techniques 2. Open surgical techniques 3. Peritoneoscopic/ laparoscopic techniques In recent years, video-assisted laparoscopy has provided new techniques for both placement and salvaging of PD catheters (Brownlee and Elkhairi 1997; Emir et al. 1997, 2000; Korten et al. 1982; Leung et al. 1998; Nijhuis et al. 1996; Owens and Brader 1995). Laparoscopic techniques have advantages: a complete intraabdominal exploration can be performed without having a formal laparotomy, the tip of the catheter can be placed into the pelvis under direct vision, and additional surgical procedures such as adhesiolysis and omentectomy can be performed. Another important advantage, especially in pediatric patients, is that the internal inguinal orifices can be inspected and that an open processus vaginalis can closed at the same time. Laparoscopy can also be used to rescue catheters that are dislodged or obstructed by omental wrapping and adhesions, thus increasing the life of the catheter. This chapter mainly describes two techniques of endoscopic surgical insertion of a PD catheter. It also discusses the role of endoscopic surgical techniques and the treatment of a number of complications. © Springer-Verlag Berlin Heidelberg 2008.