Goel S, Ribby KJ, Khanna R, Kathuria P, Twardowski ZJ, Nolph
KD, Nichols WK
Temporary stoppage of PD when laparoscopic procedures
are performed on patients undergoing CAPD/CCPD: a change in policy
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S60 1997
With an indwelling device like a peritoneal catheter, the peritonitis
risk, spontaneous or due to surgical procedures, is increased. This was
adressed for laparoscopic procedures in patients that were on peritoneal
dialysis. An increasing number of abdominal surgical interventions are done
by means of laparoscopic techniques. The question is how they interfere
with CAPD/CCPD treatment.
Goel et al compared their policies of laparoscopic interventions before and
after 1995. Prior to 1995 they kept their patients on PD whenever such an
intervention was necessary. From 1993-1995, however, they saw
post-laparoscopic peritonitis in 5/7 patients (71.4%). Starting in 1995
they instituted a deliberate policy of temporary cessation of PD for 2
weeks post laparoscopic procedure, maintaining the patient on
haemodialysis. They did not observe any peritonitis in the three patients
that underwent a laparoscopic procedure in this period.
Comment: Although the numbers shown in this study are very small,
the trend towards a better outcome of laparoscopic procedures in PD
patients seems to be there. From a pathophysiological viewpoint, one can
imagine that a peritoneum that has been irritated during laparoscopy has a
disturbed host defense, and that further PD may give small numbers of
microorganisms that entered the peritoneal cavity the opportunity to cause
full blown peritonitis. Although further studies in this area are
warranted, the observation by Goel et al is interesting enough to seriously
think over any manipulation we perform in the peritoneal region in
relationship to the treatment modality.
(Johan Rosman M.D., The Hague, Netherlands)
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