This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Case–control comparison of laparoscopic and open washout for peritoneal dialysis‐associated peritonitis. BJS 2008; 95: 1416-1419.
Published: 9th October 2008
Authors: A. D. Barlow, P. J. Yates, S. A. Hosgood, M. L. Nicholson
Background
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.
Method
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.
Results
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.
Conclusion
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. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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