Sharba method: innovative one-sided laparoscopic approach for continuous ambulatory peritoneal dialysis catheter placement

Abstract

Background. This study aims to evaluate whether modifications to the surgical technique can improve peritoneal catheter longevity. In our view, this longevity may be enhanced in two distinct ways. The proposed method facilitates the insertion of a second contralateral catheter and may offer advantages in kidney transplantation (although most procedures are now performed retroperitoneally) and other nephrological surgical interventions, due to the absence of lateral surgical access and reduced risk of adhesions, particularly in cases requiring intraperitoneal surgery. Materials and methods. The study includes 410 cases of one-sided laparoscopic continuous ambulatory peritoneal dialysis (CAPD) catheter placement between 2018 and December 2022, with data collected from our center in Najaf. Additionally, a comparative survey was conducted on 118 cases using the traditional two-sided laparoscopic CAPD technique, performed by different surgeons at another center in the same city. Our technique underwent periodic refinements to address complications observed over time, although the core procedural steps remained consistent. Techniques used by other surgeons, both domestically and internationally, vary in certain aspects while sharing similarities in others. Feedback from transplant surgeons was collected for patients who later underwent kidney transplantation, allowing comparison with other approaches and evaluation of postoperative complications potentially avoided with our method. Results. The study analyzed age distribution among patients undergoing laparoscopic CAPD, ranging from 8 months to 85 years, with the youngest excluded due to incomplete data. Comparative feedback showed slightly better outcomes for the one-sided technique, though without statistical significance (p = 0.24530). Early failure rates were higher in the two-sided group, while late catheter patency failures were more frequent in the one-sided group, mostly unrelated to the technique itself. Revision rates and success were also assessed, revealing a significantly higher success rate for the one-sided approach (95 %) compared to the two-sided method (33.33 %). Conclusions. Our findings suggest that the one-sided laparoscopic CAPD catheter insertion technique represents a promi­sing alternative to the traditional two-sided approach. It demonstrates favorable late patency outcomes and significantly higher revision success rates. Although transplant surgeon feedback slightly favored the one-sided method, the difference was not statistically significant. Further long-term studies are needed to validate these results, but this technique may help reduce complications and improve catheter longevity.