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Postoperative management and complications after abdominal surgery in children receiving peritoneal dialysis

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Abstract

Background

Patients on peritoneal dialysis (PD) may develop PD-related complications that necessitate abdominal surgery. However, when to resume PD and how to prescribe PD fluid after surgery in pediatric patients are unknown.

Methods

Patients on PD who underwent small-incision abdominal surgery between May 2006 and October 2021 were included in this retrospective observational study. The complications after surgery and characteristics of patients with PD fluid leakage were analyzed.

Results

Thirty-four patients were included. They underwent 45 surgical procedures, including 23 inguinal hernia repairs, 17 PD catheter repositioning or omentectomy, and 5 others. The median time to resume PD was 1.0 (IQR, 1.0–3.0) days, and the median PD exchange volume at the initiation of PD after surgery was 25 (IQR, 20–30) ml/kg/cycle. PD-related peritonitis occurred in two patients after omentectomy and one after inguinal hernia repair. There was no PD fluid leakage or hernia recurrence among the 22 patients who had a hernia repair. Peritoneal leakage occurred in 3 of the 17 patients who had PD catheter repositioning or an omentectomy and was treated conservatively. No patients who resumed PD 3 days after small-incision abdominal surgery with less than half of PD volume had fluid leakage.

Conclusions

Our findings demonstrated that PD could be resumed within 48 h of inguinal hernia repair with no PD fluid leakage or hernia recurrence in pediatric patients. In addition, resuming PD 3 days after a laparoscopic procedure with less than half of the usual dialysate volume might reduce the risk of PD fluid leakage.

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Data availability

The data of this study are available from the corresponding author, Koichi Kamei, upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

We would like to thank Enago Crimson Interactive Pvt. Ltd. for editing a draft of this manuscript.

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Authors and Affiliations

  1. Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan

    Yuta Inoki, Kentaro Nishi, Kei Osaka, Tomoya Kaneda, Misaki Akiyama, Mai Sato, Masao Ogura & Koichi Kamei

Authors
  1. Yuta Inoki
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  2. Kentaro Nishi
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  4. Tomoya Kaneda
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  7. Masao Ogura
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  8. Koichi Kamei
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Contributions

All the authors were physicians who treated the patients in this study. Yuta Inoki conducted the study, collected the clinical and laboratory data, and wrote the manuscript; Kentaro Nishi, Kei Osaka, Tomoya Kaneda, Misaki Akiyama, Mai Sato, and Masao Ogura reviewed and edited the manuscript; and Koichi Kamei, the corresponding author, supervised the work and revised the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Koichi Kamei.

Ethics declarations

Ethics approval

The study was conducted according to the Helsinki Declaration’s principle and the Japanese Ministry of Health, Labor, and Welfare’s ethical guidelines. The study was approved by the Ethics Committee of the National Center for Child Health and Development (approval no. 2022–101).

Consent to participate

Informed consent for participation was exempted in accordance with the Helsinki Declaration’s principle and the Japanese Ministry of Health, Labor, and Welfare’s ethical guidelines.

Consent for publication

Informed consent for publication was exempted in accordance with the guidelines.

Competing interests

Koichi Kamei has obtained research funding from the Public Foundation of Vaccination Research Center, the Terumo Foundation for Life Sciences and Arts, and the Taiju Life Social Welfare Foundation; donations from Chugai Pharmaceutical Co. Ltd., Astellas Pharma Inc., Ono Pharmaceutical Co. Ltd., Teijin Pharma Ltd., Shionogi Co. Ltd., and Otsuka Pharmaceutical Co. Ltd.; and lecture fees from Tanabe Mitsubishi Pharma, Baxter Ltd., and Zenyaku Kogyo Co. Ltd. Other authors have no potential conflicts of interest to disclose.

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Inoki, Y., Nishi, K., Osaka, K. et al. Postoperative management and complications after abdominal surgery in children receiving peritoneal dialysis. Pediatr Nephrol 38, 3427–3434 (2023). https://doi.org/10.1007/s00467-023-06009-6

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  • DOI: https://doi.org/10.1007/s00467-023-06009-6

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