Comparison Of The Conventional And Laparoscopic Placement Of Peritoneal Dialysis Catheter

Objective: Peritoneal dialysis, hemodialysis and renal transplantation are three principal methondsto treat end-stage renal disease. Among them, peritoneal dialysis is easy to carry out, protective for residual renal function andthe treatment that occupy at home. Therefore, peritoneal dialysis is an optimal choice for early dialysis. Nowadays, peritoneal dialysis catheter placement has been widely used in clinical practice,Peritoneal dialysis catheter is critical to the success of the peritoneal dialysis.In this study, we compared the general conditions betweenintraoperative and postoperative,catheter-related complications, catheter survival rate, hospital stay, medical cost and operation time between conventional and laparoscopic placement of peritoneal dialysis(PD) catheter, to provide reference for clinicians.Methods: 246 patients with chronic kidney disease(stage 5) who received catheter implantation and PD therapy from January 2008 to April 2015 in the First Affiliated Hospital of Soochow University were selected. The subjects were divided into two groups, group A(conventional placement of PD catheter, n=176) and group B(laparoscopic placement of PD catheter, n=70). The general conditions between intraoperative and postoperative,the post-operative catheter-related complications, catheter survival rate, hospital stay, medical cost and operation time were retrospectively compared for analysis.Results:(1) General condition: There was no significant differencein preoperative and postoperative general condition between the two groups(such as hemoglobin, albumin, creatinine, serum calcium, serum phosphorus and uric acid).(2)Catheter-related complications condition:The incidences of catheter migration and bleeding were significantly different between the two groups(P<0.05). There were no significant differences in leakage, catheter obstruction, peritonitis, exit-site infection or hernia.(3)Catheter survival rate condition: The catheter survival rate was similar in the two groups(P>0.05).The one-year catheter survival rate was 82.52% in group A and 67.14% in group B. The two-year catheter survival rate was 75.2% in group A and 54.29% in group B. The three-year catheter survival rate was 69.92% in group A and 42.86% in group B.(4) The operation time, medical cost and hospital stay were significantly different in operation time and medical cost between the two groups(P<0.05). The operation time was longer in group A than that in group B. The medical cost was less in group A than that in group B. The hospital stay was not significantly different between the two groups(P>0.05).(5)In the laparoscopic group,1 patient with chronic appendicitis, 4 patients with chronic cholecystitis and 8 patients with inguinal hernia received appendectomy, cholecystectomy and hernia repair, respectively. No postoperative adverse reactions occurred.Conclusion: Both placement methods have advantages and disadvantages. It takes less time to perform laparoscopic placement of peritoneal dialysis catheters. And the catheter migration rate is lower. However, the medical cost of traditional placement are significantly lower.