Laparoscopic omentectomy for peritoneal dialysis catheter flow obstruction: a case report and review of the literature.

Peritoneal dialysis catheter outflow dysfunction frequently is caused by omentum or epiploic appendices blocking the side holes of the catheter tubing. Laparoscopy has been utilized increasingly to remedy mechanical blockage of the peritoneal device. This obviates the need for catheter replacement, permits early return to dialysis, and lowers the patient dropout rate from peritoneal dialysis as a modality for renal replacement therapy. We report a case of laparoscopic subtotal omentectomy to successfully resolve recurrent catheter obstruction that failed previous omentolysis and omentopexy. Using four port sites, the omental resection was accomplished using the harmonic scalpel. The procedure was performed on an ambulatory basis, dialysis was resumed after 1 week, and there were no infectious complications or port site leaks. We define terminology to standardize reporting of omentectomy. Our technique of laparoscopic omentectomy is described and compared to those of previously published reports. The role of laparoscopic omentectomy relative to other commonly used laparoscopic approaches to the obstructed peritoneal dialysis catheter is reviewed.