Encapsulated Peritoneal Sclerosis due to Peritoneal Dialysis: Long-Term Experience Following Surgical Operation

Encapsulating peritoneal sclerosis (EPS) is the most serious complication in patients undergoing peritoneal dialysis (PD). Although conservative treatments are suggested in early stages of EPS, the condition may need surgical management in severe stages. This study presents the outcome of surgical treatment of patients with severe stages of EPS. Between 2011 and 2020, a total of nine patients with advanced EPS that were non-responsive to medical therapy were referred for surgical management and enterolysis consisting of repeated lysis of fibrin membranes and stripping the sclerotic layers was done. All patients had continuous follow-up for possible bowel obstruction according to their chief complaints, physical examination, and abdominal imaging. The median age of patients was 45 years and 66.7% (6 patients) were men. The median time of surgery was 180 min. Excluding one patient who died postoperatively, the median hospitalization period after surgery was 35 days. Patients were followed for a median of 28 months. During the follow-up period, three patients (33.3%) experienced mild and intermittent symptoms of obstruction without need to re-laparotomy. In conclusion, if conservative managements fail to resolve obstructive symptoms, referring the EPS patients for surgery as soon as possible is highly suggested. Also, trying to protect the patients from the possible intestinal perforations or intestinal resection, repairing the small perforations and doing anastomosis immediately if needed are of high importance. Following up the patients after discharging from hospital for relapsing symptoms is another mainstay of care of EPS patients.