Case-control comparison of laparoscopic and open washout for peritoneal dialysis-associated peritonitis.

Abstract

Peritonitis is the major complication of peritoneal dialysis (PD). Some 25-40 per cent of patients require surgical intervention, traditionally laparotomy, washout and removal of the PD catheter. The aim was to compare this open procedure with laparoscopic washout and catheter removal. In a case-control comparison, 20 patients who had laparoscopic washout for PD-associated peritonitis were matched by age and causative organism with 20 patients who had open washout. The groups were well matched for age, sex, causative organism, preoperative C-reactive protein level, white cell count and presence of bowel wall sclerosis. Laparoscopic surgery was quicker than open operation (mean(s.d.) 49(13) versus 73(30) min; P = 0.006) and postoperative morphine requirements were significantly lower (median 0 versus 27 mg; P < 0.001). Bowel function recovered more quickly in the laparoscopic group, as measured by time to first passage of flatus (mean(s.d.) 2(1) versus 5(4) days; P = 0.004) and resumption of free fluids (median 2 versus 4 days; P = 0.044). Reoperation rates and 30-day mortality were identical in the two groups. This study suggests that laparoscopic washout for PD peritonitis is as effective as open washout, but is quicker and less painful with earlier return of bowel function.