PREOPERATIVE DIAGNOSES:
Fungal peritonitis with peritoneal dialysis catheter and chronic kidney disease.
POSTOPERATIVE DIAGNOSES:
Fungal peritonitis with peritoneal dialysis catheter and chronic kidney disease.
PROCEDURES:
Laparoscopic removal of peritoneal dialysis catheter and abdominal washout with
placement of hemodialysis catheter tunneled.
ASSISTANT:
None.
ANESTHESIA:
General.
PROCEDURE IN DETAIL:
The patient was placed on operating table in supine position. After
administration of general anesthesia, the patient’s abdomen and chest were
prepped and draped in usual fashion. Attention was turned to the left
subclavian approach utilizing an infraclavicular approach subclavian vein was
easily cannulated. J-wire introduced. Peel-away dilator catheter was placed
over the J-wire into the vessel and the previously heparinized catheter was
placed in position through the peel-away catheter and anchored. There was good
blood return in both ports. A 7500 units in 2 mL of heparinized saline was
instilled in each port. Biopatch and sterile dressings were applied. Then,
attention was turned to the abdominal area where a supraumbilical midline
incision made and carried down the fascia. 0 Vicryl two stay sutures were
placed. The Hasson was placed. Laparoscope was then placed and a 5 mm trocar
was placed in the right lower quadrant without injury to intraabdominal
contents. The catheter was identified and easily removed early just by pulling
the catheter out and the entire catheter came out. The abdominal cavity was
then copiously irrigated with 6 L of fluid and then suctioned as well.
Cultures had been obtained from this fluid prior to the surgery. The area was
thoroughly irrigated, all fluid removed and then the fascia was closed with 0
Vicryl and staples for skin. Final sponge, needle, and instrument count
correct. Sterile dressings placed. The patient was transferred to recovery
room in satisfactory condition.