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Abstract: FR-PO678

Laparoscopic Peritoneal Dialysis Catheter Insertion Using Nitrous Oxide Under Conscious Sedation

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Saiprasertkit, Nalinee, Toronto General Hospital, Toronto, Ontario, Canada
  • Bargman, Joanne M., Toronto General Hospital, Toronto, Ontario, Canada
Background

The conventional laparoscopic peritoneal dialysis catheter implantation using carbon dioxide (CO2) for peritoneal insufflation necessitates general anesthesia (GA) due to CO2-induced peritoneal pain. However, end stage kidney disease (ESKD) patients are not generally ideal candidates for GA. Using nitrous oxide (N20) as an insufflation agent offers several advantages, including PD catheter insertion under regional anesthesia.

Methods

We performed a retrospective cohort study in ESKD patients who underwent laparoscopic PD catheter insertion with N2O under regional anesthesia from Jan 1, 2008 to May 31, 2018. Patient demographics, treatment outcomes and adverse events were collected from our electronic databases.

Results

There were 152 patients, mean age was 68.2 ± 13.2 years; 41.5% women. Most common cause of ESKD was diabetic nephropathy (25.6%). Only 2 patients had unsuccessful catheter insertion due to extensive intra-abdominal adhesions. One patient required unexpected hospitalization due to intraoperative bleeding requiring a blood transfusion. Mean follow up was 26.6±23.1 months. One-year and 2-year catheter survival rates were 90.1% and 84.9%. Mean catheter survival was 51.0 ± 7.6 months.

Conclusion

Laparoscopic implantation of PD catheter with N2O insufflation and local anesthesia is feasible and can be performed safely in end-stage renal failure patients.