Title : Possibilities and prospects of preserving peritoneal dialysis in CKD patients requiring surgical interventions on abdominal organs
Abstract:
Introduction: Laparoscopic minimally invasive surgery is increasingly used for various comorbidities, including chronic kidney disease (CKD) patients on peritoneal dialysis (PD). It was necessary to complete PD in CKD patients and transit them to program hemodialysis before colorectal cancer surgery.
Methods: We present two cases of programmed peritoneal dialysis preservation in end stage renal disease (ESRD) patients after laparoscopic left hemicolectomy with D2 lymph dissection for colorectal cancer. 2 patients with stage 5 CKD, who need dialysis, were admitted to our hospital with intestinal bleeding in 2022.
Results: The procedures were performed with the 4-trocar technique. The 10-mm trocar, usually placed in the right iliac fossa, was placed more medially to avoid the Tenckhoff catheter. At peritoneal examination, the catheter was still correctly placed in the lower pelvis. The surgery ended with abdominal drainage with the catheter retained for PD.
Conclusion: Compared with open surgery, laparoscopy is more progressive and innovative method for the various surgical and oncological diseases treatment. It is observed by lower peritoneal membrane stress and better preservation of peritoneum integrity, less adhesions formation, which affect the residual abdominal function in patients with dialysis peritonitis, and allows recovering peritoneal lavage in the shortest period. Our clinical observations demonstrate that laparoscopic left hemicolectomy can be performed safely, providing the patients with the benefits of a minimally invasive approach and keeping them on PD. A multidisciplinary approach combining modern laparoscopic surgeries, adherence to oncological principles and balanced nephrological tactics may represent a reasonable and safe strategy for surgical treatment of operable colorectal cancer with the possibility of preserving PD in the postoperative period.
Key words: peritoneal dialysis; laparoscopic hemicectomy, colon cancer.
