Dan MITOIU, Cristiana DAVID, Ileana PERIDE, Ileana VACAROIU, Andrei NICULAE, Alexandru CIOCALTEU, Ionel Alexandru CHECHERITA and Niculae IORDACHE

ABSTRACT

Introduction. Peritoneal dialyzed (PD) patients’ surgical emergencies and even routine interventions represent acts that few surgeons agree to perform, because of the complications and risks induced by this method along to those of surgery itself.

Methods. Between March 2009 and March 2014, we conducted a study including PD and hemodialyzed (HD) individuals in need of abdominal surgery, and the duration of each type of intervention was compared in the 2 groups.

Results. In the PD group, 42 surgical interventions were performed – 9 cholecystectomies, 8 intestinal occlusions, 3 appendectomies, 6 interventions for intestinal tumors, 2 gynecological interventions, 14 surgical cured hernias. In HD subjects (n = 35) we recorded: 11 cholecystectomies, 11 intestinal occlusions, 2 appendectomies, 8 intestinal tumors, 8 hernia surgical cures, 4 hysterectomies. The mean duration of surgery was 67.18+/-19.70 minutes in PD group, respectively 46.87+/-20.55 minutes in HD group, a significant statistical difference (p = 0.0032).

Conclusions. PD represents a type of renal replacement therapy with great impact on abdominal surgery conduct, highly increasing the operating time.

Keywords: peritoneal catheter, early complications, biochemical predictors

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Dan MITOIU, Cristiana DAVID, Ileana PERIDE, Ileana VACAROIU, Andrei NICULAE, Alexandru CIOCALTEU, Ionel Alexandru CHECHERITA and Niculae IORDACHE

ABSTRACT

Introduction. Early complications of peritoneal dialysis (PD) catheter restrict the applicability of the method. Highlighting and removing the predisposing factors contribute to a better survival of this renal replacement therapy.

Aims. To establish a correlations between serum albumin, urea and creatinine values before surgery and the risk of early complications after catheter insertion.

Methods. We conducted a prospective study between March 2009 and March 2014 including all patients that underwent laparoscopic insertion of Tenckhoff catheter in our hospital. Several biochemical characteristics of interest were assessed before surgery (serum albumin, BUN, creatinine) and we correlated their values in the groups of patients presenting or not early complications of PD catheter.

Results. In the total of 77 patients (mean age 60.08 +/- 11.64 years), 54.54% men, we noted 23 early complications (29.76%), of which 13 infectious complications (56.52%) and 10 mechanical complications – catheter malposition (n = 4), fluid leakage (n = 3), abdominal wall hematoma (n = 3). Low levels of serum albumin have shown positive association both with infectious and mechanical complications (p = 0.02112, respectively p = 0.01277). High values of urea and creatinine are strongly correlated to mechanical complications (p = 0.18295 and 0.18770), but not to the early infectious complications (p = 0.5754, p = 0.86001).

Conclusions. Forcing the early use of Tenckhoff catheter due to high and dangerous levels of serum urea and creatinine proved to result in increased episodes of mechanical complications; hypo-albuminemia in pre-dialysis patients correlates positively both with mechanical and infectious catheter complications in the first month after insertion.

Keywords: peritoneal catheter, early complications, biochemical predictors

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