Objective: Encapsulating peritoneal sclerosis (EPS) is a rare, but devastating complication of peritoneal dialysis comprised of chronic abdominal pain, chronic ileus, and severe malnutrition. In contrast to simple adhesiolysis, peritonectomy and enterolysis (PEEL) in EPS consists a decapsulation and a partial deserosation of the intestine. Therefore PEEL is burdened with an alarmingly high morbidity and mortality rate. We review our operated EPS patients regarding perioperative morbidity, mortality and long term outcome.
Methods: Patients with end-stage EPS were identified in our EPS-registry. Only patients who underwent partial peritonectomy and enterolysis (PEEL) were included into this study. Preoperative general status was ascertained by APACHE-II-score and body mass index. Postoperative morbidity was stratified into minor and major complications.
Results: Between 2003–2012 29 of 45 patients with end-stage EPS underwent PEEL. Three patients were operated twice due to recurrent disease, therefore 31 PEELs were performed. APACHE-II score 15 and BMI 21kg/m2. Nine bowel resections with instantaneous anastomoses were necessary. Morbidity was 44% with minor complications in 2 cases (7%) and major complications in 11 cases (31%). Three patients (10%) died postoperatively.
Conclusions: Peritonectomy and enterolysis (PEEL) in EPS is a treatment option with low mortality and acceptable morbidity. With PEEL end-stage EPS is curable. Due to complexity of the surgical procedure and the disease, EPS-patients should be treated in specialised centres.
