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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 20-22

Laparoscopic oviductal fimbrioplasty for peritoneal dialysis catheter outflow obstruction caused by ovarian fimbriae


1 Department of Surgery, College of Medicine, King Saud University, Riyadh, KSA
2 Department of Surgery, College of Medicine, Riyadh, Saudi Arabia
3 Department of Medicine, College of Medicine, King Saud University, Riyadh, KSA

Date of Web Publication25-Oct-2016

Correspondence Address:
A Aldohayan
Department of Surgery, College of Medicine, King Saud University, P. O. Box: 2925, Riyadh 11461
KSA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2542-4629.193042

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  Abstract 

Introduction: The successful maintenance of peritoneal dialysis is the outcome of well functioning of the peritoneal catheter. Catheter outflow obstruction may cripple the usage of the peritoneal catheter. Catheter migration, omental entrapment, and fibrin clots are the usual causes of this failure. Oviduct fimbriae can cause obstruction rarely.
Materials and Surgical Technique: We describe a case of a a 65-year-old woman, in whom the obstruction fimbriae was the cause of the obstruction and was managed by cleaning the catheter, and the right  fimbraepexy to the lateral wall of the peritoneal wall in the dependent part with no salpingectomy is required.
Discussion: In follow-up of 20 months, the catheter is working; this technique can be used in young patients who need to balance the risk of infertility with the risk of malfunction of peritoneal dialysis catheter.
Conclusions: Ovarian fimbria entrapment in the PDC is rarely the cause of dialysis flow obstruction, if occurs, laparoscopic management is ideal way to manage such presentation.

Keywords: Catheter; dialysis; fimbrioplasty


How to cite this article:
Aldohayan A, Alshomer F, Al-Naami M, Al-Obeed O, Bamehriz F, Tarakji A R. Laparoscopic oviductal fimbrioplasty for peritoneal dialysis catheter outflow obstruction caused by ovarian fimbriae. Saudi J Laparosc 2016;1:20-2

How to cite this URL:
Aldohayan A, Alshomer F, Al-Naami M, Al-Obeed O, Bamehriz F, Tarakji A R. Laparoscopic oviductal fimbrioplasty for peritoneal dialysis catheter outflow obstruction caused by ovarian fimbriae. Saudi J Laparosc [serial online] 2016 [cited 2019 Mar 26];1:20-2. Available from: http://www.saudijl.org/text.asp?2016/1/1/20/193042


  Introduction Top


Continuous ambulatory peritoneal dialysis and automated peritoneal dialysis are used in the management of patients with end-stage chronic renal disease. To achieve the best results, it depends on proper function of implanted peritoneal catheter. Catheter flow malfunction can reach up to 60% of patients. [1],[2] Debris within catheter lumen, malposition of the catheter, and entrapment of the catheter by abdominal structures are the causes of the malfunction of the peritoneal dialysis. Laxatives, mobilization of the patients, manipulation of the catheter by stiff wire, and fibrinolysis agents are the available methods to overcome these complications with limited success. Previously, catheter replacement was the usual method to be used, and with the introduction of laparoscopy, it widens the applications to manage the catheter malfunction. [2],[3],[4]

Laparoscopy replaces the open technique for placing the peritoneal dialysis catheter (PDC). Moreover, laparoscopy is a good modality to manage PDC malfunction. [5],[6],[7] In addition, it fasts resuming the peritoneal dialysis outflow obstruction. [8] The most common abdominal organ responsible for catheter entrapment is the greater omentum. [8] Rarely, tubal fimbriae may capture the catheter and subsequently in the growth of lumen leading to poor inflow and outflow of dialysis that has been reported. [9],[10],[11],[12],[13],[14],[15] Hereby, we extend our previous experience [17] with a novel technique in the management of PDC malfunction due to fimbriae entrapment with the preservation of fallopian tubes and fimbria.


  Materials and Surgical Technique Top


In January 2010, laparoscopic placement of double-cuff PDC was done for a 65-year-old female patient and dialysis started after the surgery under local anesthesia using our technique. [17] Four months later, poor (PDC) performance was noticed, followed by weak inflow and drainage of dialysate. A plain abdominal X-ray showed the proper position of the catheter. A trail of laxative and conservative management has failed to improve the condition. The patient was transferred temporarily to hemodialysis, and omental entrapment was suspected primarily, and laparoscopy was planned. The fimbriae of the right fallopian tube were shown to penetrate the fenestration and coiled part of the tube. The catheter was released and retrieved through the dissection port and cleaned, and irrigation is initiated. End loop 2-0 suture was applied to the right fimbriae and 2-0 is cut with length fold near the lower edge of the abdominal wall and fixed to it [Figure 1]a, b and [Figure 2]a, 2b. The patient has smooth postoperative recovery and CPD was resumed on the same day, and 20 months later, the patient used CPAD regularly. The patient was consented to share the information related to this article.
Figure 1: (a and b) Schematic illustration shows the proper placement of the peritoneal dialysis catheter and ways of fixation to the lateral abdominal wall

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Figure 2: (a and b) Intraoperative laparoscopic view of the fimbrioplasty fixed to the lateral abdominal wall away from the peritoneal dialysis catheter

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  Discussion Top


The merits of laparoscopic management of malfunctioning PDCs have been reported. [3],[8] Laparoscopy allows the examination of the catheter and identifies the cause. Moreover, correction can be carried simultaneously, resuming immediate peritoneal dialysis. [2] Omental entrapment is the most common cause of catheter flow obstruction. [8] However, the entrapment by intraperitoneal tubular structures as appendix and fallopian tube rarely can cause PDC flow dysfunction. [6],[7] There are 10 cases of catheter obstruction due to tubal fimbriae reported in literature as managed by salpingectomy in 9 patients [9],[10],[11],[12],[13],[14] and partial fibroicdectomy in a 2-year-old patient. [15] The other symptoms are vaginal discharge leak of dialysate through fallopian tube. [13] Laparoscopic and open accesses performing salpingectomy was performed to manage those complications. We manage our patient laparoscopically, which is minimally invasive and uses the primary incisions. We encountered the right tube as the cause of the obstruction which was previously reported. This may explain that the catheter is near the right tube. Similarly, eight cases were reported, [9],[10],[11],[12],[13] and in two cases, the left fallopian tube was the cause. [12],[13],[14],[15] Salpingectomy is the standard way of management. [9],[10],[11],[12],[13],[14] In contrast, we preserve the fallopian tube. The method can be applied to young patients who want to get pregnant. Moreover, the procedure is simple, less invasive, long-term, and showed its efficacy.

Salpingectomy is reported in open or laparoscopic technique. [9],[10],[14] In contrast, we report a new technique of retrieving the tube and cleaning the tube from the debris and positioning the PDC in the Douglas Pouch and fimbraepexy are hold by suture, and the other end is fixed to the abdominal wall pulling the fallopian tube away from the catheter. The incisions are closed ensuring no gas leakage to resume the PDC dialysis during laparoscopy and immediately postoperatively.

The technique avoids salpingectomy which may give a chance to pregnancy. Moreover, the incisions are 0.5 cm, lowering the risk of incisional hernia and avoid using the further instrument, and decreasing the risk of bleeding. The previously reported laparoscopic techniques have used 3 ports. On the other hand, we use 2 ports of size 5 mm, resuming peritoneal dialysis 1-7 days in reported cases. [9],[10],[11],[12],[13],[14],[15] On other hand, we performed dialysis intraoperatively and in the same day postoperatively. Therefore, our technique preserves the tubes with good function of the PDC catheter, which preserves the fertility of the patient, and may be the optimal treatment of PDC outflow obstruction, caused by oviductal fimbriae.

Ovarian fimbria entrapment of PDC may be rarely the cause of dialysate flow obstruction, which can be manifested by the lower abdominal pain and nondisplaced PDC. [16] Laparoscopic management is the ideal way to manage such presentation using fimbrioplasty in young patients, in whom fertility is a vital issue, may be the most suitable method to manage such complications, which is less invasive and low in cost.


  Conclusions Top


Ovarian fimbria entrapment in the PDC is rarely the cause of dialysis flow obstruction, if occurs, laparoscopic management is ideal way to manage such presentation.

Acknowledgments

We would like to thank the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Saudi Arabia, for their help in literature access and material organization.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Amerling R, Maele DV, Spivak H, Lo AY, White P, Beaton H, et al. Laparoscopic salvage of malfunctioning peritoneal catheters. Surg Endosc 1997;11:249-52.  Back to cited text no. 1
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2.
Brandt CP, Ricanati ES. Use of laparoscopy in the management of malfunctioning peritoneal dialysis catheters. Adv Perit Dial 1996;12:223-6.  Back to cited text no. 2
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3.
Mutter D, Marichal JF, Heibel F, Marescaux J, Hannedouche T. Laparoscopy: An alternative to surgery in patients treated with continuous ambulatory peritoneal dialysis. Nephron 1994;68:334-7.  Back to cited text no. 3
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4.
Graham SM, Flowers JL, Fritz K, Voigt R. Laparoscopic manipulation of a malfunctioning peritoneal dialysis catheter in a child. Surg Laparosc Endosc 1995;5:144-7.  Back to cited text no. 4
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5.
Kimmelstiel FM, Miller RE, Molinelli BM, Lorch JA. Laparoscopic management of peritoneal dialysis catheters. Surg Gynecol Obstet 1993;176:565-70.  Back to cited text no. 5
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6.
Owens LV, Brader AH. Laparoscopic salvage of Tenckhoff catheters. Surg Endosc 1995;9:517-8.  Back to cited text no. 6
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7.
Kittur DS, Gazaway PM, Abidin MR. Laparoscopic repositioning of malfunctioning peritoneal dialysis catheters. Surg Laparosc Endosc 1991;1:179-82.  Back to cited text no. 7
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8.
Crabtree JH, Fishman A. Laparoscopic omentectomy for peritoneal dialysis catheter flow obstruction: A case report and review of the literature. Surg Laparosc Endosc Percutan Tech 1999;9:228-33.  Back to cited text no. 8
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9.
Abouljoud MS, Cruz C, Dow RW, Mozes MF. Peritoneal dialysis catheter obstruction by a fallopian tube: A case report. Perit Dial Int 1992;12:257-8.  Back to cited text no. 9
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10.
Uchiyama K, Fujikawa K, Suga A, Naito K. Laparoscopic salvage of malfunctioning peritoneal dialysis catheters caused by ovarian fimbria: A case report. Hinyokika Kiyo 2001;47:669-71.  Back to cited text no. 10
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11.
Whiting MA, Smith NI, Agar JW. Vaginal peritoneal dialysate leakage per fallopian tubes. Perit Dial Int 1995;15:85.  Back to cited text no. 11
    
12.
Macallister RJ, Morgan SH. Fallopian tube capture of chronic peritoneal dialysis catheters. Perit Dial Int 1993;13:74-6.  Back to cited text no. 12
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13.
Klein Z, Magen E, Fishman A, Korzets Z. Laparoscopic salpingectomy: The definitive treatment for peritoneal dialysis catheter outflow obstruction caused by oviductal fimbriae. J Laparoendosc Adv Surg Tech A 2003;13:65-8.  Back to cited text no. 13
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14.
Moreiras-Plaza M, Cáceres-Alvarado N. Peritoneal dialysis catheter obstruction caused by Fallopian tube wrapping. Am J Kidney Dis 2004;44:e28-30.  Back to cited text no. 14
    
15.
Sinha R, Dastidar A. Obstruction of a peritoneal dialysis catheter by an ovarian fimbria in a 2-year-old girl. Am J Kidney Dis 2011;57:356-7.  Back to cited text no. 15
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16.
Borghol M, Alrabeeah A. Entrapment of the appendix and the fallopian tube in peritoneal dialysis catheters in two children. J Pediatr Surg 1996;31:427-9.  Back to cited text no. 16
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17.
Al-Dohayan A. Laparoscopic placement of peritoneal dialysis catheter (same day dialysis). JSLS 1999;3:327-9.  Back to cited text no. 17
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