Todd Penner

Guidelines for laparoscopic peritoneal dialysis access surgery.

The use of peritoneal dialysis (PD) as a primary mode of renal replacement therapy has been increasing around the world. The surgeon’s role in caring for these patients is to provide access to the peritoneal cavity via a PD catheter and to diagnose and treat catheter complications. Since the early 1990s, laparoscopy has been applied by many adult and pediatric surgeons for insertion of PD catheters as well as for salvage of malfunctioning catheters. This document is an evidence-based guideline based on a review of current literature and the opinions of experts in the field. It provides specific recommendations to assist surgeons who take care of adult and pediatric PD patients. Disclaimer

Hospital Costs Associated With Laparoscopic and Open Inguinal Herniorrhaphy

Purpose: The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. Methods: A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs. Results: Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost,

Peritoneal Dialysis Catheters with Back Exit Sites

3207.15 vs

Peritoneal Dialysis University for Surgeons: A Peritoneal Access Training Program

3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost,

The Enigmatic Fallopian Tube: A More Common Cause of Catheter Malfunction than Previously Recognized

4574.02 vs

Persistent epigastric pain in an 80-year-old man.

4662.89; P = .827). Conclusions: In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.

Analysis of Hospitalization after Peritoneal Dialysis Catheter Implantation

1. Matuszkiewicz–Rowinska J. Update on fungal peritonitis and its treatment. Perit Dial Int 2009; 29(Suppl 2):S161–5. 2. Li PK, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, et al. Peritoneal dialysis–related infections recommendations: 2010 update. Perit Dial Int 2010; 30:393–423. [Erratum in: Perit Dial Int 2011; 31:512] 3. Pascual A, Calandra T, Bolay S, Buclin T, Bille J, Marchetti O. Voriconazole therapeutic drug monitoring in patients with invasive mycoses improves eff icacy and safety outcomes. Clin Infect Dis 2008; 46:201–11. doi:10.3747/pdi.2012.00023

The Impact of Gastric Bypass Surgery Compared to Total Knee Arthroplasty on Knee Symptoms

♦ Background: A functioning catheter is vital to the success of peritoneal dialysis (PD). Catheter complications related to the insertion procedure remain a major hindrance to PD utilization. Most catheters are placed by surgeons. Suboptimal catheter outcomes appear to be related to inadequate training and experience during surgical residency and the absence of educational opportunities to remedy this deficit once the surgeon is in practice. ♦ Objective: The aim of this report is to describe a 1-day comprehensive surgeon training program in PD access surgery and to convey the results of the first 7 courses. ♦ Methods: Needs assessment data served as the foundation for formulating course objectives and content. A disease-based approach to PD was taken to provide both didactic instruction and laboratory exercises. Surgical simulators permitted skills development for each key task in catheter placement. Educational outcomes were measured with pre- and post-tests, course evaluation, and follow-up survey. ♦ Results: Seven courses were attended by 134 surgeons with an average faculty to participant ratio of 1:4 during hands-on laboratory sessions. Pre- and post-testing demonstrated a class-average normalized educational gain of 50%. On a 5-point Likert scale, the course was scored highly on 14 areas of evaluation with average responses ranging from 4.4 to 4.9. A follow-up survey conducted a mean of 28 months after the programs revealed significantly increased utilization of all 10 course-targeted PD access skills. Participants gave mean scores of 4.6 for improved confidence in case management and 4.4 for better catheter outcomes. ♦ Conclusions: A comprehensive 1-day peritoneal access training course can produce long-term self-assessed improvement in surgical management and PD catheter outcomes.

Ultrasound-guided transversus abdominis plane (TAP) block for laparoscopic gastric-bypass surgery: a prospective randomized controlled double-blinded trial.

Successful performance of peritoneal dialysis (PD) depends on a properly functioning PD catheter. Catheter malfunction remains a significant cause of technique failure, especially early in the course of therapy. Common causes of catheter malfunction include catheter displacement, omental or bowel wrapping, and fibrin clots. Less commonly, various intraperitoneal structures have been reported to lead to obstruction, including appendices epiploicae of sigmoid colon and the fallopian tube. Peritoneal dialysis catheter blockage due to fimbriae of the fallopian tube is being recognized as an important cause of catheter malfunction in females due to the increasing availability of diagnostic laparoscopy. We report 5 episodes of catheter malfunction in 4 patients on PD from a single center as a result of obstruction by the fallopian tube.

Warfarin-induced gastric bleeding and intestinal obstruction

An 80-year-old man presented with a one-week history of constant epigastric pain and left-sided exertional chest pain. On the day of presentation, he had experienced four episodes of nonbilious vomiting, but had no other gastrointestinal symptoms. He did not report fever, chills or sweats. There was