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Son Dönem Böbrek Hastalığı Hastalarında Peritoneal Diyaliz Kateteri Yerleştirilmesinde Laparoskopik ve Konvansiyonel Yöntemlerin Karşılaştırılması: Tek Merkez Deneyimi

A Comparison of Laparoscopic and Conventional Methods in Peritoneal Dialysis Catheter Placement in Patients with End-Stage Renal Disease: Single Center Experience

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DOI: 
10.5262/tndt.2014.1003.02
Abstract (2. Language): 
OBJEC TIVE: There is no consensus on superiority of peritoneal dialysis catheter placement methods to each other in the literature.Therefore, the aim of this study was to determine whether there were differences in complications between laparoscopic and percutaneous PD catheter placement methods performed in our hospital. MATER IAL and ME THODS: Forty patients with ESRD files were evaluated retrospectively. The patients were divided into two groups according to the placement method of PD catheters; namely, the Percutaneous Group (PG) and the Laparoscopic Group (LG). RE SUL TS: Dialysate leakage was seen only in one patient in PG (3.33%) while it was not seen in LG (p= 0.75). Malposition was detected only in five patients in PG (16.7%) and it was not seen in LG (p= 0.22). Catheter dysfunction occurred in four patients in PG (13.3%) while it was not seen in LG (p= 0.30). Hemoperitoneum did not develop in PG while it appeared in one patient (10%) in LG (p=0.25). Early peritonitis was detected in four patients in PG (13.3%) and in one (10%) patient in LG (p = 0.78). Exit site infection developed only in 10 patients (33.3%) from PG; however, it did not develop in LG (p=0.04). CONCLU SION: Percutaneous PD catheter placement was preferred in our center, and fewer complications were observed with laparoscopic methods. We recommend laparoscopic PD catheter placement in patients with morbid obesity, prior abdominal surgery, herniation or malposition developing due to the percutaneous method and where percutaneous fixation is not possible.
Abstract (Original Language): 
AMAÇ: Literatürde periton kateter yerleştirme yöntemlerinden herhangi birinin diğerine üstünlüğü ile ilgili görüş birliği yoktur. Bu çalışmada, laparoskopik ve perkütan yöntemler ile SAPD kateter yerleştirilmesinin komplikasyonları açısından fark araştırıldı. GERE Ç ve YÖNTEMLER : 2007 ile 2012 yılları arasında ANEAH Nefroloji Kliniği takibinde olan SDBH tanılı 40 hastanın sonuçları retrospektif olarak değerlendirildi. Hastalar SAPD kateter yerleştirilmesi yöntemine göre iki gruba ayrıldı; perkütan grup (PG) ve laparoskopik grup (LG). BUL GUL AR: PG de bir hastada (%3,33) diyalizat kaçağı ortaya çıktı, LG de ise diyalizat kaçağı görülmedi (p= 0,75). LG de malpozisyon bulunmazken, PG’deki 5 (%16,7) hastada malpozisyon saptandı (p= 0,22). PG de 4 (%13,3) hastada kateter fonksiyonel bozukluğu gelişirken, LG’de böyle bir komplikasyon oluşmadı (p= 0,30). Hemoperitoneum sadece LG’deki 1 (%10) hastada görüldü (p= 0,25). Erken peritonit PG’deki dört (%13,3) hastada görülürken LG’de bir (%10) hastada görüldü (p= 0,78). Çıkış yeri enfeksiyonu PG’de on (%33,3) hastada saptandı, LG’de ise gözlenmedi (p= 0,04). SONUÇ: Merkezimizde periton diyalizi için öncelikle perkütan yöntemler tercih edilmek ile beraber laparoskopik yöntemlerle daha az komplikasyon geliştiği görülmektedir. Morbid obezite hastalarında, geçirilmiş abdominal cerrahi öyküsü olanlarda, eşlik eden fıtık varlığında ve perkütan yöntem ile malpozisyon gelişip perkütan olarak düzeltilemeyen hastalarda laparoskopik yöntem ile periton kateteri yerleştirilmesini önermekteyiz.
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