Efficiency of laparoscopic technique of access formation for peritoneal dialysis

Abstract

Peritoneal dialysis is an effective method of renal replacement therapy. Currently, different opinions have been put forward as to which catheter implantation technique is preferable for peritoneal dialysis. In this study, the application of the laparoscopic implantation technique for peritoneal dialysis catheter and improving the effectiveness of peritoneal dialysis in patients with stage 5 chronic kidney disease is substantiated. The study included 1,228 patients with stage 5 chronic kidney disease who received medical care by peritoneal dialysis and were observed in 26 dialysis centers between 2000 and 2020. Group 1 received open implantation technique (n = 1105 people; 477 men [43%], 628 women [57%]). The average age at the time of implantation of peritoneal dialysis catheter was 52.4 ± 0.48 years. Group 2 received laparoscopic implantation technique (n = 123; 57 men (46%), 66 women (54%)). At the beginning of 2000, peritoneal dialysis was maintained in 78 patients but was continued in 45 people. The average age at the time of implantation of the peritoneal dialysis catheter was 51.9 ± 1.28 years. Compared with group 1, group 2 demonstrated better “survival” because of the lower dysfunction and catheter loss rates, increased opportunities for using peritoneal dialysis in patients with previous abdominal surgery. In both groups, peritoneal dialysis was mainly terminated because of complications. The technical “survival” of the peritoneal dialysis was significantly higher in women and patients who were overweight in group 2 than in group 1. The proportion of patients without infectious complications was significantly lower in group 2 than in group 1. Thus, laparoscopic implantation of the peritoneal dialysis catheter improves the quality of treatment, expands the indications for its use, and increases peritoneal dialysis “survival”. In addition, both surgical options (open and laparoscopic implantation techniques for peritoneal dialysis catheter) can be employed; however, the laparoscopic technique is preferred in women and patients who are overweight because they reduced the conversion rate to hemodialysis. Accordingly, the introduction of an advanced laparoscopic technique for implanting a peritoneal dialysis catheter into the clinical practice of making access for peritoneal dialysis is necessary.