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 Table of Contents  
GUEST EDITORIAL
Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 3-4

Laparoscopic treatment strategies for peritoneal catheter malfunction by ovarian fimbriae


Department of Medical Specialties, Nephrology and Dialysis Unit, "Carlo Urbani" Hospital, Jesi, Italy

Date of Web Publication25-Oct-2016

Correspondence Address:
Zeiler Matthias
Nephrology and Dialysis Unit, "Carlo Urbani" Hospital, Via Aldo Moro n. 25, Jesi
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2542-4629.193037

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How to cite this article:
Matthias Z, Stefano S. Laparoscopic treatment strategies for peritoneal catheter malfunction by ovarian fimbriae. Saudi J Laparosc 2016;1:3-4

How to cite this URL:
Matthias Z, Stefano S. Laparoscopic treatment strategies for peritoneal catheter malfunction by ovarian fimbriae. Saudi J Laparosc [serial online] 2016 [cited 2017 Oct 21];1:3-4. Available from: http://www.saudijl.org/text.asp?2016/1/1/3/193037

Peritoneal catheter malfunction is a common but feared complication of peritoneal dialysis. The risk of peritoneal catheter malfunction is approximately 15% per year. At laparoscopy, in 80% of cases, malfunction is caused by displacement and/or omental wrapping, followed by adhesions, endoluminal thrombi, catheter kinking, occlusion by adnexal tissue or epiploic appendices, and incorrect placement of the catheter. [1]

The indication for videolaparoscopy is the failure of noninvasive procedures to restore catheter functions such as enemas and laxatives, forced flushing or aspiration of dialysis fluid throughout the catheter, heparin or fibrinolytic administration, intraluminal manipulation with metal guidewires, endoscopic brushes, ureteral catheters, or Fogarty catheters.

There are only unspecific clinical signs of malfunction by ovarian fimbriae. Catheter occlusion by peritubular or ovarian tissue can be suspected in case of catheter malfunction, despite correct position in abdomen X-ray, in the presence of vaginal leakage of peritoneal fluid or blood, pain in the lower abdomen, or hemorrhagic peritoneal dialysis fluid. [1],[2],[3] Only laparoscopy can correctly identify the origin of peritoneal catheter malfunction.

The obstruction of the peritoneal catheter by oviductal fimbriae might be more frequent as published, as not all cases of catheter malfunction are investigated by laparoscopy. [2] At least 10-20 cases of peritoneal catheter malfunction due to entrapment of peritubular tissue have been reported in the form of case reports or case series of restricted number. Based on these external and personal experiences, the laparoscopic treatment strategies can be classified into four main approaches as follows:

  • Stripping away the fimbriae from the peritoneal catheter or removing partially peritubular tissue: This approach is the less invasive procedure and thus performed more frequently. Theoretically, the risk of a recurrence is not reduced by this approach. In literature, long-term successful follow-up has been documented. [1],[4] We suggest this approach at the first presentation of catheter malfunction by oviductal fimbriae, especially in patients in fertile age, as peritoneal dialysis will be only a bridge therapy to transplantation
  • Fixing the fallopian tube or ovary away from the catheter: This approach is less invasive than laparoscopic salpingectomy. Furthermore, it leaves intact the fallopian tube. A disruption of the mesosalpinx will not take place. In children in peritoneal dialysis, the fixation of the uretero-ovarian ligament to the psoas muscle as well as preventive ovariopexy at peritoneal catheter placement were reported with the good long-term outcome, respectively, prolongation of catheter survival. [5],[6] Whether the "pexy" approach will alter fertility is not known. We suggest this approach in case of recurrence of catheter obstruction in patients in fertile age
  • Fixing the peritoneal catheter away from the fallopian tube: The change of peritoneal catheter position by fixing the catheter medially to the anterior abdominal wall or inside the pelvic cavity will enlarge the distance to the ovarian fimbriae. [3],[7] In general, the anterior abdominal wall fixation technique reduces significantly the incidence and recurrence of catheter malfunction by dislocation. [5] This approach can be combined with the previously mentioned laparoscopic approaches
  • Laparoscopic salpingectomy: This approach is the most invasive approach, but the most resolving strategy. As surgical removal of a fallopian tube reduces the natural fertility rate, we propose this approach, especially to women in postmenopausal age or in case of relapsing malfunction.
In terms of good ethical practice, we suggest a preoperative discussion about fertility issues in patients of fertile age because salpingopexy, ovariopexy, and salpingectomy might alter the natural fecundability rate.

All peritoneal accesses should be closed by purse string sutures at the end of the intervention to avoid leakage of dialysis fluid, as in most cases, peritoneal dialysis will be recommenced immediately after surgery.

An alternative to video-guided laparoscopy is the manual externalization of the intraperitoneal catheter segment though a minilaparotomy. [8] The occluding tissue is removed manually and the cleared catheter repositioned within the peritoneal cavity. We believe that this technique should only be considered when laparoscopy is contraindicated or not available because preventive measures of catheter malfunction are not performed.

Whether a specific configuration of the intraperitoneal segment of the catheter, classic Tenckhoff, curled or self-locating type, or the peritoneal dialysis prescription itself, continuous ambulatory peritoneal dialysis or automated peritoneal dialysis, are associated with the entrapment of peritubular tissue cannot be deduced from the literature.

Generally, laparoscopic treatment of peritoneal catheter malfunction is successful in over 90% of cases in the short term, and the technical survival of the catheter is prolonged by an average of 6-20 months in retrospective studies.

 
  References Top

1.
Santarelli S, Zeiler M, Marinelli R, Monteburini T, Federico A, Ceraudo E. Videolaparoscopy as rescue therapy and placement of peritoneal dialysis catheters: A thirty-two case single centre experience. Nephrol Dial Transplant 2006;21:1348-54.  Back to cited text no. 1
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2.
Gudsoorkar PS, Penner T, Jassal SV, Bargman JM. The enigmatic fallopian tube: A more common cause of catheter malfunction than previously recognized. Perit Dial Int 2016;36:459-61.  Back to cited text no. 2
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3.
Macallister RJ, Morgan SH. Fallopian tube capture of chronic peritoneal dialysis catheters. Perit Dial Int 1993;13:74-6.  Back to cited text no. 3
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4.
Numanoglu A, McCulloch MI, Van Der Pool A, Millar AJ, Rode H. Laparoscopic salvage of malfunctioning Tenckhoff catheters. J Laparoendosc Adv Surg Tech A 2007;17:128-30.  Back to cited text no. 4
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5.
Numanoglu A, Rasche L, Roth MA, McCulloch MI, Rode H. Laparoscopic insertion with tip suturing, omentectomy, and ovariopexy improves lifespan of peritoneal dialysis catheters in children. J Laparoendosc Adv Surg Tech A 2008;18:302-5.  Back to cited text no. 5
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6.
Zeidan S, Akkary R, Ghabril R, Diab N, Abou-Jaoude P. Why remove, when you can preserve. Kidney Int 2014;86:1275.  Back to cited text no. 6
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7.
Doubel PA, Vansteenkiste FP, Schockaert OP. A gripping case of peritoneal dialysis catheter malfunction. Kidney Int 2015;87:483.  Back to cited text no. 7
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8.
Kim SH, Lee DH, Choi HJ, Seo HJ, Jang YS, Kim DH, et al. Minilaparotomy with manual correction for malfunctioning peritoneal dialysis catheters. Perit Dial Int 2008;28:550-4.  Back to cited text no. 8
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