Biomedical subjects

Arnold Fishman

Publications and source records attributed to Arnold Fishman.

4 recordsLinked to original sources

PubMed2005

A laparoscopic method for optimal peritoneal dialysis access.

Both medical benefits to the patient and financial incentives to the health care system exist to increase the use of peritoneal dialysis as renal replacement therapy. Providing long-term peritoneal access free of mechanical dysfunction continues to represent a major challenge to the success of this modality. Variable outcomes result from the lack of standard implantation methodology and failure to address persistent problems associated with current implantation techniques. This prospective case study compared noninfectious procedural complications of three approaches to establish peritoneal dialysis access. The groups consisted of 63 catheters implanted by traditional open dissection, 78 catheters implanted by basic laparoscopy without associated interventions, and 200 catheters implanted by advanced laparoscopic methods including rectus sheath tunneling, selective prophylactic omentopexy, and selective adhesiolysis. Mechanical flow obstruction, the major outcome indicator, followed only 1 of 200 (0.5%) implantation procedures in the advanced group and was significantly better (P < 0.0001) than the open dissection (17.5%) and basic laparoscopic (12.5%) groups. A low rate of pericannular leaks (1.3-2%) was not different for the three groups. One pericannular hernia occurred in the open group. Catheter mechanical dysfunction attributable to the surgical technique can nearly be eliminated through adjunctive procedures made possible only by a laparoscopic approach.

Catheters, Indwelling↗

PubMed2003

Laparoscopic implantation of swan neck presternal peritoneal dialysis catheters.

The swan neck presternal peritoneal dialysis catheter provides an alternative location from which a catheter can exit the skin when an abdominal site is not suitable. The exit site is in the upper anterior chest. The presternal catheter was designed for patients who would not ordinarily be considered for peritoneal dialysis because of body habitus, presence of stomas, or urinary-fecal incontinence. In its original design, the catheter can be implanted only by open dissection. We present a modification of the catheter system and describe an operative technique in which the catheter can be inserted laparoscopically. Eight patients underwent laparoscopic implantation of presternal catheters by this technique. During follow-up ranging from 2.9 to 12.4 months (average, 5.3 months), no instances of catheter dysfunction, leakage around the cannula, hernia, or loss secondary to infection occurred. We foresee greater use of the swan neck presternal peritoneal dialysis catheter once surgeons become more familiar with its ease of insertion and if the device can be made available as a single-package system compatible with laparoscopic implantation.

Catheters, Indwelling↗

PubMed2003

Selective performance of prophylactic omentopexy during laparoscopic implantation of peritoneal dialysis catheters.

Omental entrapment of the peritoneal dialysis catheter remains a common cause of flow dysfunction. Prophylactic omentectomy during catheter implantation is still followed with an incidence of flow obstruction as high as 10%. We describe indications and a technique for selective performance of omentopexy during laparoscopic catheter implantation that resulted in only a 0.7% obstruction rate in 153 consecutive patients as compared with a 12.8% rate in a preceding group of 78 consecutive patients. Laparoscopic omentopexy was performed during 9.2% of implant procedures and only when the omentum was found to extend to the retrovesical space. The procedure is simple, quick, and inexpensive to perform. Employing selective criteria for omentopexy eliminates the performance of unnecessary procedures. Actuarial analysis demonstrates that an operative strategy of selectively performing omentopexy for redundant omentum significantly improves catheter survival free of flow dysfunction (P < 0.0001).

Catheterization, Peripheral↗

PubMedDate not supplied

The efficacy of silver-ion implanted catheters in reducing peritoneal dialysis-related infections.

BACKGROUND: Dialysis-related infections are the commonest cause of catheter loss and transfer to hemodialysis. Surface modifications of the catheter that reduce infections are of major importance. OBJECTIVE: The efficacy of silver-ion treated catheters in reducing dialysis-related infections was tested. METHODS: The study design was a prospective, randomized controlled trial. Patients were implanted with either a silver-treated study catheter or a control catheter. Prospective collection of data included infectious complications and catheter survival. RESULTS: The subject groups were comprised of 67 silver-treated catheters and 72 control catheters. Demographic characteristics of the study and control groups were equal. Exit-site infection rates for the study group and control group (0.52 and 0.45 episodes/patient-year of dialysis respectively) were not different by Poisson regression analysis (p > 0.4). Peritonitis rates were identical for the two groups (0.37 episodes/patient-year) and were not different by Poisson analysis (p > 0.9). Antibiotic-free intervals between infections for the study and control groups were not significantly different for exit-site infections (p = 0.58), peritonitis (p = 0.44), or both infections combined (p = 0.47). Actuarial analyses showed no differences between the groups in the probability of remaining free of exit-site infection (p > 0.2) or peritonitis (p > 0.7). Similarly, catheter survival was not significantly different between the groups (p > 0.6). CONCLUSION: Surface modification of catheters with ion beam implantation of silver produced no clinical effect with respect to reducing dialysis-related infections.

Adult↗