Complications - Peritoneal dialysis: Laparoscopic-assisted catheter insertion in CAPD

Injury to abdominal organs

•  Minilaparotomy for open establishment of the pneumoperitoneum
• Atraumatic dissection
• Careful intraabdominal application of electrosurgery
• Dissection only under direct view

Bleeding

• Transillumination of the abdominal wall
• Subtle dissection
• Introducer set best inserted through the medial rectus muscle

Almost all injuries seen in laparoscopic surgery are reasonably easy to control if they are noticed immediately and treated appropriately, e.g., by arresting any bleeding, suturing any intestinal injuries. In case of doubt: Convert to open surgery!

Secondary bleeding

• Compression dressing, suture ligation, revision surgery

Peritonitis

• Revision laparoscopy, possibly laparotomy

Wound infection

• Open wound care

Cutaneous emphysema

• Disappears by itself

Postlaparoscopic shoulder pain syndrome

• Symptomatic treatment

Kinking

• Kinking may be avoided by deep subcutaneous tunneling, palpation of the subcutaneous course of the catheter, careful marking of the incisions before surgery with the patient standing and supine.

Catheter malposition, leakage

• These problems may be avoided by careful intraoperative inspection under direct laparoscopic view.

Abdominal wall infection

• If the catheter must be explanted due to severe infection of the abdominal wall, in most cases it is possible during the same operation to insert a new catheter on the contralateral side, thereby obviating the need for temporary hemodialysis.