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Surgery. 2013 Feb;153(2):219-24. doi: 10.1016/j.surg.2012.07.033. Epub 2012 Sep 14.

Efficacy and morbidity of surgical therapy in late-stage encapsulating peritoneal sclerosis.

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1
Department of General, Visceral Surgery, Robert-Bosch Hospital, Stuttgart, Germany.

Abstract

BACKGROUND:

Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis composed of chronic abdominal pain, chronic ileus, and severe malnutrition. Operative therapy for EPS is a complex procedure, including perionectomy and enterolysis (PEEL). In contrast to simple adhesiolysis, PEEL comprises a restitution of intestinal passage and prevention of recurrent disease by decapsulation and partial deserosation.

METHODS:

We reviewed the treatment of patients with EPS at our referral center regarding perioperative morbidity, mortality, and long-term outcome. Only patients who underwent PEEL were included. Preoperative general status was ascertained by APACHE-II score and body mass index. Postoperative morbidity was stratified into minor and major complications.

RESULTS:

Between the years 2003 and 2010, 26 of 45 patients with late-stage EPS underwent PEEL. Median age was 54 years, APACHE-II score was 15, and body mass index was 21 kg/m². To achieve intestinal function, 9 bowel resections with immediate anastomoses were necessary. Eleven patients (37%) received a complete parietal peritonectomy. Overall morbidity was 44%, with minor complications in 2 patients (7%) and major complications in 11 patients (31%). Three patients (10%) died within the first year after operative treatment.

CONCLUSION:

PEEL is a treatment option that can be performed with low mortality and acceptable morbidity. It is a precondition that these patients are treated in specialized referral centers.

PMID:
22981361
DOI:
10.1016/j.surg.2012.07.033
[Indexed for MEDLINE]

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