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A novel technique of sutureless omentopexy during dual-incision laparoscopic peritoneal dialysis catheter insertion to prevent catheter dysfunction due to omental wrapping

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Abstract

Background

Omental wrapping (OW) is the leading cause of obstruction of the peritoneal dialysis (PD) catheter, which interferes with dialysis treatment. Routinely or selectively performing omentopexy during laparoscopic PD catheter placement has been suggested to prevent OW. However, most of the published techniques for performing this adjunctive procedure require additional incisions and suturing. Herein, we aimed to report our experience in performing omentopexy with a sutureless technique during dual-incision PD catheter insertion. We also performed a comparative analysis to assess the benefit/risk profile of routine omentopexy in these patients.

Methods

This retrospective study enrolled 469 patients who underwent laparoscopic PD catheter insertion. Their demographic characteristics and operative details were collected from the database of our institution. Omentopexy was performed by fixing the inferior edge of the omentum to the round ligament of the liver using titanium clips. For analysis, the patients were divided into the omentopexy group and the non-omentopexy group. We also reviewed the salvage management and outcomes of patients who experienced OW.

Results

The patients were categorized into the omentopexy (n = 81) and non-omentopexy (n = 388) groups. The patients in the non-omentopexy group had a higher incidence of OW, whereas no patient in the omentopexy group experienced this complication (5.2% vs. 0.0%, p = 0.033). The median operative time was 27 min longer in patients who underwent omentopexy than in those who did not [100 (82–118) min vs. 73 (63–84) min, p < 0.001]. One patient had an intra-abdominal hematoma after omentopexy and required salvage surgery to restore catheter function. The complication rate of omentopexy was 1.2% (1/81).

Conclusion

Sutureless omentopexy during laparoscopic PD catheter insertion is a safe and reliable technique that does not require additional incisions and suturing. Routinely performing omentopexy provides clinical benefits by reducing the risk of catheter dysfunction due to OW.

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Acknowledgements

The authors sincerely appreciated the assistance of all the PD nurses.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan

    Hao-Wei Kou, Chun-Nan Yeh, Chun-Yi Tsai, Chao-Wei Lee, Jun-Te Hsu, Shang-Yu Wang, Ming-Chin Yu & Tsann-Long Hwang

  2. Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated By Chang Gung Medical Foundation), Tu-Cheng, New Taipei, Taiwan

    Ming-Chin Yu

  3. Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital, Puzih, Chiayi County, Taiwan

    Wen-Hsin Chen

  4. Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Chien-Chih Chiu

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  1. Hao-Wei Kou
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  2. Chun-Nan Yeh
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Correspondence to Tsann-Long Hwang.

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Hao-Wei Kou, Chun-Nan Yeh, Chun-Yi Tsai, Jun-Te Hsu, Chao-Wei Lee, Shang-Yu Wang, Ming-Chin Yu, Wen-Hsin Chen, Chien-Chih Chiu, and Tsann-Long Hwang have no conflicts of interest or financial ties to disclose.

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Kou, HW., Yeh, CN., Tsai, CY. et al. A novel technique of sutureless omentopexy during dual-incision laparoscopic peritoneal dialysis catheter insertion to prevent catheter dysfunction due to omental wrapping. Surg Endosc 37, 148–155 (2023). https://doi.org/10.1007/s00464-022-09449-7

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  • DOI: https://doi.org/10.1007/s00464-022-09449-7

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