Peritoneal dialysis in the challenging abdomen: A retrospective review examining the role of obesity and adhesions.

BackgroundPeritoneal dialysis (PD) is an increasingly common modality for end-stage kidney disease patients. Laparoscopic peritoneal dialysis catheter placement (LPDC) may allow for successful outcomes in patients considered to have difficult abdomens for PD.MethodsThis was a retrospective review of 505 consecutive patients who underwent attempted LPDC between July 2009 and May 2024 by a single surgeon. Intraoperative decision making and rate of complications were evaluated in patients with/without comorbidities. Hazard ratio calculations using Cox regression and P-values were calculated using SPSS.ResultsAverage age of the study population is 53.4 ± 14.8 years, 45.1% (n = 228) were female, and 60.2% (n = 304) were Black. Average BMI was 31.7 ± 7.3. Two hundred ninety-two patients (57.8%) had previous abdominal surgery. LPDC could not be done safely in 13 patients (2.6%). Lysis of adhesions at initial placement was needed in 186 patients (36.8%). BMI > 35 kg/m² did not increase the risk of revision with a hazard ratio (HR) of 0.9 (0.6-1.4). Adhesiolysis did not increase the risk of revision (HR 1.3 (0.9-1.9)). Catheter-related complications required revision in 122 patients (24.7%). Catheter-related complications did not vary significantly between those who had (n = 104, 21.1%) and had not had adhesiolysis (n = 91, 18.5%, P > .05). Two or more revisions were required in 35/492(7.1%) patients. One-year modified patency rate was 94.1% (446/474).ConclusionThis represents one of the largest reported single surgeon experiences in LPDC. Laparoscopic techniques can help provide a feasible option for long-term dialysis in patients with a difficult abdomen and the disease of obesity.