Randomized Prospective Comparison of Laparoscopic and Open Peritoneal Dialysis Catheter Insertion

Objective To compare laparoscopic and conventional peritoneal dialysis catheter insertion with respect to post operative discomfort, complication rates, and catheter survival. Design Randomized prospective study. Setting Tertiary referral renal unit. Patients Fifty patients commencing peritoneal dialysis. Intervention Catheters were implanted laparoscopically or by a conventional surgical technique. Main Outcome Measures The duration of surgery, hospital stay, pain scores, and analgesic requirements were recorded. Complications (early/late) and catheter survival were compared. Results The conventional procedure was faster than the laparoscopic (14.3 vs 21.9 minutes, p < 0.0001). There was no difference in any other parameter assessed. Conclusions The data suggest that the insertion techniques are equivalent, and that laparoscopic insertion does not reduce early complication rates.

Download Full-text

Percutaneous insertion of peritoneal dialysis catheter is a safe and effective technique irrespective of BMI

10.21203/rs.2.10345/v2 ◽

2020 ◽

Author(s):

Dayang Xie ◽

Jianhui Zhou ◽

Xueying Cao ◽

Qingtao Zhang ◽

Yanli Sun ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Catheter Insertion ◽

Percutaneous Technique ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Peritoneal Catheter ◽

Catheter Survival ◽

The Difference ◽

One Year ◽

The One

Abstract Background. A large body mass index (BMI) has been considered as a relative contraindication for percutaneous catheter insertion , although this technique has many advantages. Up to now, there are few studies on peritoneal catheter placement and obesity. The aim of this study was to determine whether patients with large BMI can also choose the percutaneous technique for peritoneal dialysis catheter insertion. Methods. 187 consecutive patients underwent peritoneal catheter insertions in the Chinese PLA General Hospital between January 1, 2015 and December 31, 2016, with 178 eligible cases being included in the analysis. Two groups were created based on the catheter insertion techniques, the percutaneous group (group P) and the surgical group (group S). Subgroups were created according to BMI>28 or≤28. The outcomes included catheter related complications and catheter survival. Results. Total infectious complication rates were significantly lower in group P than in group S. The late peritonitis rates tended to be lower in group P than in group S, although the difference was not significant. There were no significant differences in all other measured complications between the two groups. Though the one-year infection-free catheter survival in group P was 7.5% higher than group S, the difference was not significant. The one-year dysfunction-free catheter survival, one-year dysfunction-and-infection-free catheter survival, and overall catheter survival were similar between the two groups. Subgroup analyses showed a superior one-year infection-free catheter survival of percutaneous technique in patients with BMI>28, which was confirmed by Kaplan-Meier analysis. Conclusions. Despite the challenges that may be encountered with patients who have a large BMI, the percutaneous technique is a safe and effective approach to placing a peritoneal dialysis catheter.

Download Full-text

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

The Journal of Vascular Access ◽

10.1177/1129729820961970 ◽

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.

Download Full-text

Percutaneous insertion of peritoneal dialysis catheters by the nephrologist (modified Seldinger technique)

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v4i4.63393 ◽

2021 ◽

Vol 4 (4) ◽

pp. 277-288

Author(s):

Karlien Francois ◽

Dieter De Clerck ◽

Tom Robberechts ◽

Freya Van Hulle ◽

Stefan Van Cauwelaert ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Infectious Complications ◽

Catheter Insertion ◽

Seldinger Technique ◽

Prior History ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Catheter Survival ◽

Set Up ◽

Percutaneous Insertion

A proper functioning access to the peritoneal cavity is the first and foremost requirement to start peritoneal dialysis. Most commonly, peritoneal dialysis catheters are inserted using a surgical approach. Laparoscopic peritoneal dialysis catheter insertion is the recommended surgical technique because it offers to employ advanced adjunctive procedures that minimize the risk of mechanical complications. In patients with low risk of mechanical catheter complications, such as patients without prior history of abdominal surgery or peritonitis, and in patients ineligible for general anesthesia, the percutaneous approach of peritoneal dialysis catheter insertion is an alternative to surgical catheter insertion. Percutaneous insertion of peritoneal dialysis catheters can be performed by a dedicated nephrologist, interventional radiologist, surgeon or nurse practitioner under local anesthesia, either with or without image guidance using ultrasound or fluoroscopy. Several reports show similar catheter function rates, mechanical and infectious complications and catheter survival for percutaneously inserted peritoneal dialysis catheters compared to surgically inserted peritoneal dialysis catheters. This article describes the percutaneous insertion of peritoneal dialysis catheters technique adopted at Universitair Ziekenhuis Brussel since 2015. Our technique is a simple low-tech modified Seldinger procedure performed by the nephrologist and not using fluoroscopy guidance. We describe the excellent outcomes of our percutaneously inserted peritoneal dialysis catheters and offer a practical guide to set up your own percutaneous catheter insertion program.

Download Full-text

Percutaneous insertion of peritoneal dialysis catheter is a safe and effective technique irrespective of BMI

10.21203/rs.2.10345/v1 ◽

2019 ◽

Author(s):

Dayang Xie ◽

Jianhui Zhou ◽

Xueying Cao ◽

Qingtao Zhang ◽

Yanli Sun ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Catheter Insertion ◽

Percutaneous Technique ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Peritoneal Catheter ◽

Catheter Survival ◽

The Difference ◽

One Year ◽

The One

Abstract Background A large body mass index (BMI) has been considered as a relative contraindication for percutaneous catheter insertion, although this technique has many advantages. Up to now, there are few studies on peritoneal catheter placement and obesity. The aim of this study was to determine whether patients with large BMI can also choose the percutaneous technique for peritoneal dialysis catheter insertion. Methods 187 consecutive patients underwent peritoneal catheter insertions in the Chinese PLA General Hospital between January 1, 2015 and December 31, 2016, with 178 eligible cases being included in the analysis. Two groups were created based on the catheter insertion techniques, the percutaneous group (group P) and the surgical group (group S). Subgroups were created according to BMI>28 or≤28. The outcomes included catheter related complications and catheter survival. Results Total infectious complication rates were significantly lower in group P than in group S. The late peritonitis rates tended to be lower in group P than in group S, although the difference was not significant. There were no significant differences in all other measured complications between the two groups. Though the one-year infection-free catheter survival in group P was 7.5% higher than group S, the difference was not significant. The one-year dysfunction-free catheter survival, one-year dysfunction-and-infection-free catheter survival, and overall catheter survival were similar between the two groups. Subgroup analyses showed a superior one-year infection-free catheter survival of percutaneous technique in patients with BMI>28, which was confirmed by Kaplan-Meier analysis. Conclusions Despite the challenges that may be encountered with patients who have a large BMI, the percutaneous technique is a safe and effective approach to placing a peritoneal dialysis catheter.

Download Full-text

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

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00003 ◽

2015 ◽

Vol 35 (5) ◽

pp. 576-585 ◽

Cited By ~ 12

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.

Download Full-text