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

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.