Myths in Peritoneal Dialysis

Martin B. Lee; Joanne M. Bargman

Disclosures

Curr Opin Nephrol Hypertens. 2016;25(6):602-608. 

In This Article

Myth 1: Peritoneal Dialysis Is Contraindicated in Patients With Previous Abdominal Surgery, Including Caesarean Section

It is commonly believed that prior open abdominal surgery and caesarean section via midline incisions are associated with intraperitoneal adhesions that will cause peritoneal dialysis catheter malfunction. However, the extent of adhesions is difficult to predict noninvasively without open or laparoscopic exploration. Physicians may, therefore, recommend haemodialysis over peritoneal dialysis for these patients even though peritoneal dialysis may otherwise have been the preferred modality.

Crabtree et al.[1] studied 436 patients undergoing peritoneal dialysis catheter insertion. Adhesions were extensive enough to require adhesiolysis in 32% of patients with prior abdominal surgery versus 3.3% of patients with no prior surgery. The need for adhesiolysis ranged from 22.7% of patients with one prior surgery to 52% of patients with at least four prior surgeries. Adhesiolysis resulted in a low-catheter insertion failure rate of only 1.8%. Obstructed catheters were rescued laparoscopically, resulting in catheter losses of 0.7%. Long-term catheter survival was comparable between patients with and without prior surgery. The authors stated that abdominal scars do not predict the extent of adhesions and the feasibility of peritoneal dialysis.

Keshvari et al.[2] found adhesions in 27% of peritoneal dialysis catheter insertions in patients with prior abdominal surgery. The incidence of mechanical catheter complications and catheter revision was comparable between patients with and without adhesions. The 2014 guidelines of the Society of American Gastrointestinal and Endoscopic Surgeons state that prior abdominal surgery is not a contraindication to peritoneal dialysis in centres with surgical expertise in laparoscopic adhesiolysis and catheter insertion.[3]

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