Use of laparoscopy in the management of malfunctioning peritoneal dialysis catheters.

The proper function of peritoneal dialysis (PD) catheters can be compromised by catheter malposition, fibrin clot, or omental wrapping. The purpose of this study was to determine the efficacy of laparoscopy in the treatment of malfunctioning PD catheters. All patients undergoing laparoscopy for catheter dysfunction at MetroHealth Medical Center in Cleveland, Ohio, from 1991 to 1995, were reviewed. Twenty-six laparoscopies were performed in 22 patients, for malfunction occurring an average of 3.9 months following insertion (range 0.5-18 months). Omental and/or small below wrapping as present in all but three cases. Lysis of adhesions was required in 19 of 26 cases, with repositioning only in seven. Eight patients had failed attempts at stiff wire manipulation prior to laparoscopy. Perioperative complications occurred in seven cases, consisting of temporary dialysate leakage (2), enterotomy (1), and early reocclusion (4). Repeat laparoscopy was successful in three of these four reocclusions. The overall success rate (catheter function > 30 days after laparoscopy) was 21/22 (96%). Laparoscopy is highly accurate and effective in the management of peritoneal dialysis catheter dysfunction and results in prolongation of catheter life.