Transverse Abdominal Incision for Encapsulated Peritoneal Sclerosis: A Surgical Secret

Background: Encapsulating peritoneal sclerosis related to long-term peritoneal dialysis is a serious and complicated clinical dilemma and surgical treatment might be the final therapeutic option when bowel obstruction occurred. However, the operative therapy comprising peritonectomy and enterolysis is a complex and risky procedure, and the surgical mortality is mainly related to the iatrogenic intestinal perforation. Methods: Between January 2010 and December 2012, there were 10 patients diagnosed with encapsulated peritoneal sclerosis who underwent surgical interventions in our hospital. Their medical records were reviewed and the general characteristics including operative time, blood loss, postoperative visual analogue scale score, surgical complications, and mortality were collected and analyzed. Results: We introduce a transverse incision option to decrease the possibility of iatrogenic intestinal perforation and finally result in better clinical outcome. Conclusions: Compared with traditional longitudinal incision, transverse incision can provide a potential surgical plan from the pre-existing loculated ascites and avoid adhesive bowel loops over the dangerous sector created by peritoneal dialysis catheter. However, further retrospective or prospective cohort study with larger sample size is still required to confirm the exact benefit of this new surgical technique.