Surgical Aspects of Continuous Ambulatory Peritoneal Dialysis in Infants, Children and Adolescents

Abstract

The importance of surgical contributions to successful pediatric continuous ambulatory peritoneal dialysis is demonstrated in this review of the experience with 9 pediatric patients maintained on such dialysis for 2-21 mo. (mean 11.3 mo.). Specific surgical procedures for pediatric peritoneal catheter placement were developed that ensure proper catheter position, establish a watertight seal at the peritoneum and provide for intraoperative demonstration of good catheter function. Peritoneography at the time of catheter placement predicted accurately later clinical hernia development and may be used to repair prophylactically subclinical inguinal and umbilical defects that are only demonstrable by intraoperative peritoneography. Partial omentectomy also was helpful in certain instances. Since institution of the techniques described in this report, these 9 patients accumulated 101 patient-mo. on continuous ambulatory peritoneal dialysis without a single catheter failure. The benefits of this as yet unrestricted extension of peritoneal catheter functional life span may be attributed to the catheter-protective features of the continuous ambulatory peritoneal dialysis method itself and the involvement of interested surgeons as active members of the pediatric continuous ambulatory peritoneal dialysis program.