scholarly journals P1220COMPARISON OF PERITONEAL DIALYSIS CATHETER INSERTION TECHNIQUES BY NEPHROLOGISTS: SURGICAL METHOD VS BLIND METHOD USING A TROCAR

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Seok Hui Kang ◽  
Jong Won Park ◽  
Kyu Hynag Cho ◽  
Jun Young Do
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Patient Death ◽  
Surgical Method ◽  
Surgical Methods ◽  
Significant Difference ◽  
Insertion Techniques

Abstract Background and Aims Successful PD requires timely peritoneal dialysis catheter (PDC) insertion and management of PDC related complications. Some societies have recently made an effort to increase PD and PDC insertion by nephrologists is an important issue. The aim of the present study was to evaluate comparative analysis of PDC insertion between blind and surgical methods by nephrologists. Method We reviewed medical records at a tertiary medical center in Korea and identified 249 adults who underwent first-time PDC insertion. All PDC insertions were performed using the blind or surgical methods. In our hospital during study period, two of three nephrologists performed the blind method routinely in all of eligible patients (blind group, n = 144). One of three nephrologists performed the surgical method in all of eligible patients (surgical group, n = 105). During follow-up, we collected data regarding peritoneal dialysis peritonitis (PDP), exit site and/or tunnel infection (ESI/TI). Catheter survivor was defined as maintaining of PD at July 2019 or PDC removal by PDC unrelated problems such as patient death due to PDC unrelated factors, kidney transplantation, patient demand, inadequate PD, improved renal function, poor oral intake due to abdominal distension, and colon cancer. Catheter non-survivor and/or PDC associated removal was defined as PDC removal by PDC related problems such as PDP, ESI/TI or PDC malfunction. Intervention-free non-survivor was defined as PDC revision, removal, or exchange by PDC related problems. Results Mean age at the PDC insertion in blind and surgical groups were 57.5 ± 13.7 and 56.3 ± 12.9 years, respectively (P = 0.640). There were no significant differences in age, sex, body mass index, underlying disease of ESRD, and Davies comorbidity index between the 2 groups. Mean follow-up durations were 37.0 ± 26.3 and 32.6 ± 23.4 months in the blind and surgical groups, respectively (P = 0.172). Total numbers of patients with one or more PDP events during follow-up period were 72 (50.0%) and 42 (40.0%) in blind and surgical groups (P = 0.118). Total numbers of PDP episodes were 157 and 100, respectively. Total numbers of patients with one or more ESI/TI events during follow-up period were 14 (9.7%) and 7 (6.7%) in blind and surgical groups (P = 0.392). Total numbers of ESI/TI episodes were 27 and 8, respectively. The 5-year PDC survival rates were 87.0% and 91.1% in the blind and surgical groups, respectively (P = 0.995, Figure 1). The 5-year intervention-free survival rates were 79.6% and 77.0% in the blind and surgical groups, respectively (P = 0.723). The leading cause of PDC removal was patient death. There was no significant difference in the distributions of cause of PDC removal in the 2 groups (P = 0.335). PDC associated removal rates in blind and surgical groups were 14 (18.4%) and 9 (16.4%), respectively (P = 0.760). Conclusion Our study shows that catheter outcomes including infectious and mechanical complications and catheter survival are similar between blind and surgical insertion techniques by nephrologists.

scholarly journals Preperitoneal Tunneling – a Novel Technique in Peritoneal Dialysis Catheter Insertion

2014 ◽  
Vol 34 (4) ◽  
pp. 443-446 ◽  
Author(s):  
Mohammad-Hadi Saeed Modaghegh ◽  
Gholamhossein Kazemzadeh ◽  
Yaser Rajabnejad ◽  
Fatemeh Nazemian
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Safe Method ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Novel Technique ◽  
Omental Wrapping

IntroductionThis study describes a new preperitoneal tunneling (PPT) method for inserting a peritoneal dialysis catheter (PDC), thereby lessening surgical complications and increasing the catheter's survival.MethodsThis new technique was used in 23 cases from December 2005 to January 2007 and followed up until March 2011 (63 months). The procedure was performed laparoscopically under local (16 cases) or general (7 cases) anesthesia by one surgeon. Catheter survival is reported by Kaplan-Meyer analysis.ResultsThe catheters were mechanically obstructed in 2/23 cases (8.7%); and were withdrawn due to a peritonitis in 2 cases and inadequacy of peritoneal dialysis in 1 case. Ten patients received kidney transplantation and six died before completing this follow-up period. The patients still reaped the benefits of the PDC until receiving a kidney transplant or death. The 5-year survival rate of the catheter was 89%. No incidence of catheter migration, omental wrapping, herniation or leakage was noticed.ConclusionPreperitoneal tunneling is a simple and safe method for insertion of PDC, and can effectively prevent catheter migration, dislocation and omental wrapping.

Outcomes of Combined Hernia Repair and Peritoneal Dialysis Catheter Placement: A NSQIP Analysis

2018 ◽  
Vol 84 (10) ◽  
pp. 1604-1607 ◽  
Author(s):  
Cynthia M. Tom ◽  
Emily D. Dubina ◽  
Eric R. Simms ◽  
Christian De Virgilio ◽  
Ashkan Moazzez
Keyword(s):  
Peritoneal Dialysis ◽  
Hernia Repair ◽  
Operative Time ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Catheter Placement ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Significant Difference ◽  
Reoperation Rates

Historically, hernias were repaired before peritoneal dialysis (PD) catheter placement to obviate hernia complications, or after PD catheter placement once hernias became symptomatic or complicated. The aim of this study was to evaluate the outcomes and safety of combined hernia repair and PD catheter placement (HPD) compared with PD catheter placement alone. Within the NSQIP databases (2005–2014), 4406 patients who underwent PD catheter placement alone and 330 patients who underwent HPD were identified. Thirty-day outcomes were compared. Overall, HPD patients were older (61 vs 57 years, P < 0.001), male (72.4% vs 56.1%, P < 0.001), and more likely to have ascites (3.6% vs 1.0%, P < 0.001). Umbilical hernias (87.9%) were most commonly repaired. There was no significant difference in mortality, morbidity, superficial surgical site infection, deep SSI, organ/space SSI, readmission, or reoperation rates. HPD was associated with shorter length of stay (1.1 vs 1.7 days, P = 0.010) and longer mean operative time (66.1 vs 43.7 minutes, P < 0.001). On multivariate analyses, HPD was not an independent predictor of morbidity or mortality. In conclusion, HPD can be safely performed to prevent future complications and additional operations.

A modified laparoscopic peritoneal dialysis insertion technique, the ‘one scar technique’ can minimise short and long term complications: A retrospective cohort study

2020 ◽  
pp. 112972982096197
Author(s):  
Aya Musbahi ◽  
Venkatesh Kanakala
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Insertion ◽  
Complication Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Insertion Technique ◽  
Catheter Migration ◽  
Significant Difference ◽  
Modification Technique ◽  
Post Modification

Introduction: Peritoneal dialysis is a renal replacement therapy that has advanced in technique over the last few decades. In this study, we describe a novel method for laparoscopic peritoneal dialysis catheter insertion and fixation and compare its outcome to standard laparoscopic insertion technique with better cosmetic outcome. Method: Peri-operative and follow up data was collected retrospectively for 184 patients undergoing peritoneal dialysis catheter insertion from September 2012 to September 2018. Results: The post-modification technique showed no difference in catheter blockage rates, incisional hernia or catheter replacement rates. A significant difference was found in catheter migration rate and exit site infections and overall complication rates, found to be lower using the new technique. Conclusion: A modification of the laparoscopic peritoneal dialysis technique is superior to standard laparoscopic insertion with a cosmetically more appealing outcome due to one visible.

Outcomes of Peritoneal Dialysis Catheter Left in Place after Kidney Transplantation

2017 ◽  
Vol 37 (6) ◽  
pp. 651-654 ◽  
Author(s):  
Saúl Pampa-Saico ◽  
Fernando Caravaca-Fontán ◽  
Víctor Burguera-Vion ◽  
Víctor Diéz Nicolás ◽  
Estefanía Yerovi-León ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Graft Function ◽  
Optimal Time ◽  
Complication Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection

No clear consensus has been reached regarding the optimal time to remove the peritoneal dialysis catheter (PDC) after kidney transplantation (KT). This retrospective observational study, conducted in a single peritoneal dialysis (PD) unit including all PD patients who received a KT between 1995 - 2015, was undertaken to evaluate the clinical outcomes and potential complications associated with a PDC left in place after KT. Of the 132 PD patients who received a KT, 20 were excluded from the study. Of the remaining, 112 (85%) patients with functioning KT were discharged with their PDC left in place and had it removed in a mean interval of 5 ± 3 months after KT, after achieving optimal graft function. During this follow-up period, 7 patients (6%) developed exit-site infection and there were 2 cases (2%) of peritonitis; all of them were successfully treated. Delayed PDC removal after KT is associated with low complication rates, although regular examination is needed so that mild infections can be detected early and therapy promptly instituted.

Predictors of Survival and Technique Success after Reinsertion of Peritoneal Dialysis Catheter following Severe Peritonitis

2007 ◽  
Vol 27 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Sue D. Cox ◽  
Stephen B. Walsh ◽  
Muhammad M. Yaqoob ◽  
Stanley L.-S. Fan
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Catheter ◽  
Technique Survival ◽  
Dialysis Vintage ◽  
Significant Difference ◽  
Severe Peritonitis ◽  
Group 2 ◽  
Technique Failure ◽  
Group 1

Background Peritonitis remains the most important complication of peritoneal dialysis (PD). The success rate of restarting PD after severe peritonitis (peritonitis unresolved despite treatment with appropriate antibiotics for 3 days, or fungal or pseudomonas infections) is unclear. We wished to determine PD technique survival and overall mortality when PD is offered to these patients and to identify predictors of successful reinitiation. Method We conducted a retrospective single-center study of 556 patients undergoing PD between January 2000 and December 2001. We collected demographic information from the 106 patients who had their PD catheter removed for peritonitis, details about their dialysis history and peritonitis, and whether they successfully restarted PD and if not, the reason. Results We divided patients into groups as follows: group 1 ( n = 42) underwent catheter reinsertion, group 2 ( n = 16) had no medical contraindication to restarting PD but the patients elected to remain on hemodialysis, group 3 ( n = 35) were deemed medically unsuitable to return to PD, and group 4 ( n = 13) were those that died within 4 weeks of presenting with peritonitis. If there were no medical contraindications, Indo-Asians were more likely to retry PD. In group 1, after a mean follow-up of 20 ± 7.3 months, 23 of 42 patients restarted PD successfully. Technique survival for group 1 as a whole was 69% at 3 months and 55% at the end of follow-up. Patients of greater dialysis vintage were more likely to develop PD technique failure after restarting. Of those judged suitable for PD, there was no statistically significant difference in the mortality of patients who wished to either restart PD or remain on hemodialysis (group 1 vs group 2). Significant numbers of patients returned successfully to PD after pseudomonas and fungal peritonitis. Conclusion Restarting PD after severe peritonitis was possible and safe. Ethnicity was an important predictor for wanting to retry PD, but not for technique failure: given the choice, Indo-Asians preferred PD and had a higher failure rate after restarting, but this did not reach statistical significance. Only dialysis vintage predicted technique failure. We conclude that, after severe peritonitis, patients should be given the choice to return to PD but risk stratification based on dialysis vintage is important. Patient retraining and creating a backup arteriovenous fistula might minimize morbidity in these high-risk patients.

Minimally invasive ‘pull technique’ for peritoneal dialysis catheter removal

2020 ◽  
pp. 089686082091502 ◽  
Author(s):  
Jian Wang ◽  
Xiao-Sheng Li ◽  
Feng-Xia Zhang ◽  
Run-Xiu Wang ◽  
Feng Cao ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Minimally Invasive ◽  
Tensile Force ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Noninvasive Method ◽  
Silicone Tube ◽  
Invasive Method ◽  
The Mean

A simple, noninvasive method for removing peritoneal dialysis (PD) catheters, called the “pull technique,” has become popular in recent years. Physicians still worry, however, about the range of its application and possible complications such as infection of the retained cuff and breakage. We, therefore, applied this technique in patients and enriched its administration for removing PD catheters. Altogether, 24 PD catheter removals in 24 patients were reviewed during the period from July 2018 to October 2019 in our hospital. Using the pull technique, the PD catheter’s superficial cuff was dissected using an electronic knife, and the deep cuff was retained. All patients’ catheters were successfully removed with no breakage. No incision or retained cuff was infected during the follow-up period (1.1–15.6 months). The appropriate peak force of pull traction was approximately 12–13 pounds, not very different from the mean maximum tensile force of 21.48 pounds for silicone tube breakage. The use of intermittent (rather than sustained) traction may reduce the breakage risk of the silicone tube. This method is a safe, practical, minimally invasive method for removing PD catheters, and it is suitable for application on special patients with peritonitis or who are on an immunosuppressant.

scholarly journals Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum

2015 ◽  
Vol 35 (5) ◽  
pp. 576-585 ◽  
Author(s):  
Samar Medani ◽  
Wael Hussein ◽  
Mohamed Shantier ◽  
Robert Flynn ◽  
Catherine Wall ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Surgery ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Catheter Survival ◽  
Significant Difference ◽  
History Of ◽  
First Time

BackgroundThe percutaneous Seldinger method of peritoneal dialysis catheter (PDC) insertion has gained favor over recent years whereas traditionally it was reserved for patients considered not fit for general anesthesia. This blind technique is believed to be less safe, and is hence avoided in patients with previous laparotomy incisions. Reports on the success of this method may therefore be criticized for selection bias. In those with no prior abdominal surgery the optimal method of insertion has not been established.MethodsWe retrospectively reviewed the outcomes of first-time PDC placements comparing the percutaneous (group P) and surgical (group S) insertion techniques in patients without a history of previous abdominal surgery in a single center between January 2003 and June 2010. We assessed catheter survival at 3 and 12 months post-insertion and compared complication rates between the two groups.ResultsA total of 63 percutaneous and 64 surgical catheter insertions were analyzed. No significant difference was noted in catheter survival rates between group P and group S (86.2% vs 80% at 3 months, p = 0.37; and 78.3% vs 71.2% at 12 months, p = 0.42 respectively). Early and overall peritonitis rates were similar (5% vs 5.3%; p = 1, and 3.5 vs 4.9 episodes per 100 patient-months; p = 0.13 for group P and group S respectively). There were also no significant differences between the two groups in exit site leaks (15.9% in group P vs 6.3% in group S; p = 0.15), poor initial drainage (9.5% in group P vs 10.9% in group S, p = 0.34) or secondary drainage failure (7.9% in group P vs 18.8% in group S, p = 0.09).ConclusionThis study illustrates the success and safety of percutaneous PDC insertion compared with the open surgical technique in PD naive patients without a history of prior abdominal surgery. Catheter survival was favorable with percutaneous insertion in this low-risk patient population but larger prospective studies may help to determine whether either method is superior. The percutaneous technique can be recommended as a minimally invasive, cost-effective procedure that facilitates implementing an integrated care model in nephrology practice.

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