Laparoscopic repositioning of a malpositioned peritoneal dialysis catheter using an abdominal wall anchoring technique: A case report

Abstract

Introduction

Peritoneal dialysis (PD) catheters can sometimes change their position spontaneously and become dysfunctional, typically requiring a complete replacement.

Case presentation

A 6-year-old boy with Wolf–Hirschhorn syndrome and chronic kidney disease had a PD catheter placed laparoscopically via a left pararectal incision, with the catheter tip positioned in the pouch of Douglas. On the 20th postoperative day, the PD catheter became dysfunctional. Evaluation by a plain abdominal film showed that the PD catheter had migrated spontaneously to the upper abdomen. Instead of replacing it, we decided to reposition the PD catheter and anchor it to the abdominal wall to prevent further migration. To do that, we placed two percutaneous stitches of non-reabsorbable material under laparoscopic guidance. To manipulate the catheter and place the stitches around it, we did a trans-umbilical laparoscopic approach with two ports through an ad-hoc device placed in the umbilicus. The percutaneous stitches went in and out the abdomen through the abdominal and anchored the PD catheter in such a way that the end was in the pouch of Douglas, unable to become dislodged again. The two stitches were spaced 10 mm apart from each other. The postoperative course was uneventful, and the PD catheter remained functional and in the correct position for 6 months until it was removed because it was no longer needed.

Conclusion

Malpositioned PD catheters may be repositioned and secured by anchoring them to the abdominal wall with transparietal stitches.