Melanie B LaPlant1, Daniel A Saltzman1, Bradley J Segura1, Robert D Acton1, Brad A Feltis2, Donavon J Hess3. 1. Division of Pediatric Surgery, Department of Surgery, University of Minnesota, 2450 Riverside Ave S. MB 505, Minneapolis, MN, 55454, USA. 2. Pediatric Surgical Associates, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA. 3. Division of Pediatric Surgery, Department of Surgery, University of Minnesota, 2450 Riverside Ave S. MB 505, Minneapolis, MN, 55454, USA. hessx006@umn.edu.
Abstract
PURPOSE: Peritoneal dialysis (PD) is a commonly used method for renal support in pediatric patients and can be associated with the risk of post-surgical complications. We evaluated method of placement of PD catheters with regard to post-surgical complications. METHODS: PD catheters placed at two institutions between 2005 and 2017 were reviewed. Complication rates were evaluated based on method of placement, delayed usage, omentectomy, and patient age using Fisher's exact test, two-sided, with significance set at 0.05. Factors influencing complication were evaluated with multivariate logistic regression and Kaplan-Meier survival analysis. RESULTS: There were 130 patients with 157 catheters placed, ranging in age from 1 day to 23 years. There was no significant difference in complication rate by method of placement or delayed usage. Infants were significantly more likely to experience leakage (21% vs 8%, p 0.036) and hernias (15% vs 5%, p 0.030). Patients that underwent an omentectomy were less likely to require a catheter replacement (7% vs 27%, p 0.004), and the catheters had a significantly higher survival rate (p 0.009). We found that laparoscopic intervention resulted in catheter salvage. Lateral exit sites may be a risk factor for catheter migration in some patients. CONCLUSIONS: Omentectomy is associated with longer PD catheter survival. Laparoscopic salvage of dysfunctional catheters may be a valuable adjunct in management.
PURPOSE: Peritoneal dialysis (PD) is a commonly used method for renal support in pediatric patients and can be associated with the risk of post-surgical complications. We evaluated method of placement of PD catheters with regard to post-surgical complications. METHODS:PD catheters placed at two institutions between 2005 and 2017 were reviewed. Complication rates were evaluated based on method of placement, delayed usage, omentectomy, and patient age using Fisher's exact test, two-sided, with significance set at 0.05. Factors influencing complication were evaluated with multivariate logistic regression and Kaplan-Meier survival analysis. RESULTS: There were 130 patients with 157 catheters placed, ranging in age from 1 day to 23 years. There was no significant difference in complication rate by method of placement or delayed usage. Infants were significantly more likely to experience leakage (21% vs 8%, p 0.036) and hernias (15% vs 5%, p 0.030). Patients that underwent an omentectomy were less likely to require a catheter replacement (7% vs 27%, p 0.004), and the catheters had a significantly higher survival rate (p 0.009). We found that laparoscopic intervention resulted in catheter salvage. Lateral exit sites may be a risk factor for catheter migration in some patients. CONCLUSIONS: Omentectomy is associated with longer PD catheter survival. Laparoscopic salvage of dysfunctional catheters may be a valuable adjunct in management.
Authors: Jennifer L Carpenter; Sara C Fallon; Sarah J Swartz; Paul K Minifee; Darrell L Cass; Jed G Nuchtern; Ashwin P Pimpalwar; Mary L Brandt Journal: J Pediatr Surg Date: 2016-02-11 Impact factor: 2.545
Authors: Alp Numanoglu; Leo Rasche; Michael A Roth; Mignon I McCulloch; Heinz Rode Journal: J Laparoendosc Adv Surg Tech A Date: 2008-04 Impact factor: 1.878