Laparoscopic peritoneal dialysis catheter insertion with omentopexy—sparing the omentum in children
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In brief
In brief
This study compares laparoscopic peritoneal dialysis catheter placement with omentopexy versus omentectomy in 30 pediatric patients, demonstrating that omentopexy preserves the omentum for future surgical needs without increasing omental obstruction risk. Catheter loss rates were comparable between groups, with failures primarily linked to prior abdominal surgery rather than the preservation technique.
- Laparoscopic omentopexy during PD catheter insertion preserves the omentum for future reconstructive procedures in pediatric patients.
- No catheter failures were directly caused by omentopexy; losses correlated with prior abdominal surgery history instead.
- Omentopexy offers a viable alternative to routine omentectomy while maintaining catheter function in children requiring peritoneal dialysis.
- Laparoscopic approach enables proper catheter positioning and complete peritoneal assessment with minimal invasiveness.
- Previous abdominal surgery is a significant risk factor for catheter loss regardless of omental management technique.
Written by the GCMD Library team from the article.
Abstract
Introduction
Continuous ambulatory peritoneal dialysis is an important modality of renal replacement therapy in children. Catheter dysfunction (commonly obstruction) is a major cause of morbidity and is a significant concern that hampers renal replacement therapy. As omentum is a significant cause of obstruction, some recommend routine omentectomy during insertion of the peritoneal dialysis catheter. Omentopexy rather than omentectomy has been described in adults to spare the omentum as it may be needed as a spare part in many conditions. Laparoscopic approach is commonly preferred as it provides global evaluation of the peritoneal space, proper location of the catheteral end in the pelvis and lesser morbidity due to inherent minimally invasive nature.
Aim
The aim of this study is to present the technique of laparoscopic peritoneal dialysis catheter placement in children with concurrent omentopexy.
Methods
We retrospectively evaluated our patients who underwent laparoscopic placement of peritoneal dialysis catheter with concomitant omentopexy or omentectomy.
Results
A total of 30 patients were enrolled who received either omentectomy (n = 18) or omentopexy (n = 12). Four catheters were lost in the omentopexy group (33%) and 3 in the omentectomy group (17%), but none were related to omental obstruction. Three out of 4 patients in the omentopexy group and 2 out of 3 patients in the omentectomy group had a previous abdominal operation as a potential cause of catheter loss. Previous history of abdominal surgery was present in 6 patients (50%) in the omentopexy group and 3 patients (17%) in the omentectomy group.
Conclusions
As omentum was associated with catheter failure, omentectomy is commonly recommended. Alternatively, omentopexy can be preferred in children to spare an organ that may potentially be necessary for many surgical reconstructive procedures in the future. Laparoscopic peritoneal dialysis catheter placement with concomitant omentopexy appears as a feasable and reproducible technique. Although the catheter loss seems to be higher in the omentopexy group, none was related with the omentopexy procedure and may be related to the higher rate of history of previous abdominal operations in this group.