• World journal of surgery · Jan 2015

    Laparoscopic peritoneal dialysis catheter insertion using nitrous oxide under procedural sedation.

    • Robert Wu, Allan Okrainec, and Todd Penner.
    • University of Ottawa, The Ottawa Hospital - General Campus, 501 Smyth Rd., Ottawa, ON, K1H 8L6, Canada, rowu@toh.on.ca.
    • World J Surg. 2015 Jan 1; 39 (1): 128-32.

    BackgroundLaparoscopic peritoneal dialysis catheter (LPDC) implantation using nitrous oxide (N2O) pneumoperitoneum under procedural sedation is a technique that has many advantages over conventional insertion methods. The purpose of this study was to review the LPDC insertion results at our center.MethodsData from 87 consecutive patients who underwent LPDC insertion was retrospectively reviewed. All procedures were attempted under procedural sedation. After patients received intravenous and local anesthesia, a N2O pneumoperitoneum was established. Peritoneal dialysis (PD) catheters were advanced using rectus sheath tunneling. The position of the catheter was confirmed by laparoscope, and adjunct procedures such as omentopexy and adhesiolysis were performed on select patients to prevent catheter flow problems.ResultsNitrous oxide was well tolerated by 94 % of the patients. Only five patients required conversion to general anesthesia. After a mean follow-up of 18.2 months, mechanical complications included pericatheter/incision leakage (12.62 %), flow obstruction (4.60 %), incision/exit site hernia (3.45 %), hemoperitoneum (2.30 %), pleuroperitoneal fistula (1.15 %), scrotal leak (1.15 %), and migration (1.15 %). Infectious complications included exit site infection (1 episode per 312.95 patient-months) and peritonitis (1 episode per 31.93 patient-months). Revision-free catheter survival was 97.6 % after 1 year.ConclusionLaparoscopic implantation of a PD catheter with N2O pneumoperitoneum and local anesthesia is safe and effective in patients with severe renal failure. N2O is an inert gas and better tolerated as an insufflation agent, enabling awake procedures. Our results show that catheter-related functional outcomes are comparable to those in the existing literature. This approach can be recommended as a good option for catheter implantation in patients needing dialysis.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…