Mini-Laparotomy Implantation of Peritoneal Dialysis Catheters: Outcome and Rescue

2010 ◽  
Vol 30 (5) ◽  
pp. 513-518 ◽  
Author(s):  
Po-Jen Yang ◽  
Chih-Yuan Lee ◽  
Chi-Chuan Yeh ◽  
Hsiao-Ching Nien ◽  
Tun-Jun Tsai ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Laparoscopic Surgery ◽  
Postoperative Care ◽  
Catheter Insertion ◽  
Exit Site ◽  
Tenckhoff Catheter ◽  
Experienced Surgeon ◽  
Catheter Obstruction ◽  
Surgical Methods ◽  
Mini Laparotomy

BackgroundContinuous ambulatory peritoneal dialysis is one of the main treatments for end-stage renal disease. To correct mechanical outflow obstruction after open surgical methods of catheter insertion, laparoscopic techniques are widely employed.MethodsBetween January 2001 and December 2006, 228 open Tenckhoff catheter implantations were carried out by mini-laparotomy in 218 patients at our medical center. The procedures were all performed by an experienced surgeon, and the postoperative care, patient education, and long-term follow-up were all conducted by the same peritoneal dialysis team.ResultsInfection of the exit site or tunnel was the most common complication (27/228, 11.8%), followed by peritonitis (18/228, 7.9%) and refractory mechanical catheter obstruction (9/228, 3.9%). The main causes of catheter removal were successful renal transplantation (21/228, 9.2%), peritonitis (18/228, 7.9%), and infection of the exit site or tunnel (7/228, 3.1%). In the 9 cases of refractory mechanical catheter obstruction, laparoscopic surgery was performed to identify the pathology and to rescue the catheter at the same time. Omental wrapping was the major cause (8/9) of catheter obstruction, with blood clot in the lumen and tube migration occurring in the remaining case (1/9). Partial omentectomy was performed in 5 patients to prevent recurrent obstruction. Neither technique failure nor operation-related complications were noted in our laparoscopic rescue group. For 20 of the 25 patients with refractory infection of the exit site or tunnel, the salvage technique of partial re-plantation was performed, with an 85% (17/20) technique survival rate.ConclusionsWith an experienced surgeon and a good postoperative care team, open paramedian placement is a simple, safe, and effective method for Tenckhoff catheter insertion, with a low complication rate. Laparoscopic surgery is effective as rescue for mechanical obstruction, and partial re-plantation is effective as salvage for exit-site or tunnel infection.

scholarly journals P1202EPIDEMIOLOGICAL AND EVOLUTIONARY PROFILE OF MECHANICAL COMPLICATIONS IN PERITONEAL DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Safa Fattoum ◽  
Barbouch Samia ◽  
Hajji Mariem ◽  
Braiek Nessrine ◽  
Mesbahi Tasnim ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Average Duration ◽  
Exit Site ◽  
Mechanical Complications ◽  
Catheter Obstruction ◽  
Different Types ◽  
Average Body Mass ◽  
Technique Failure ◽  
Average Body ◽  
Mini Laparotomy

Abstract Background and Aims The success of peritoneal dialysis (PD) depends on a functional and sustainable peritoneal access. The mechanical complications of PD (MCPD) are a major cause of technique failure. The aim of the study was to determine the different types of these complications and to define their prevalence. Method It’s a retrospective study conducted in our PD unit in December 2019. We collected all data concerning clinical characteristics of all patients currently in PD, as well as incidence, type, outcome of MCPD. Results There were 90 patients with an average age of 45 years (extremes: 20.5 years and 80.6 years). The sex ratio is 1.25. Fourteen were diabetic (15.5%). All patients were on Automated PD (APD) except one on Continuous Ambulatory PD (CAPD). The average duration of PD was 40.5 months. The average body mass index (BMI) was 23,8 kg/m? All patients had a Tenckhoff 2 cuff catheter placed by a mini laparotomy. Twenty six episodes of MCPD were noted in 17 patients (18,8%).The complications noted were early dialysate leakage in 2 patients(2,2%) spontaneously resolving before the beginning of the training, catheter obstruction in 8 patients(3 patients presented 3 episodes of obstruction each) (8,8%), umbilical hernia in 3 patients (3,3%), 2 patients had displaced repositioned catheter (2,2%). Five patients (5,5%) presented continued inflammation in the exit-site of the catheter: the outermost of the two Dacron cuffs spontaneously extruded in 2 patients, and was surgically extracted in 3 patients. Cuff externalization resolved the inflammation in all patients. Conclusion Successful access for PD placed by a trained operator is crucial in purpose to avoid MCPD. These complications must be treated on time to avoid technique failure.

Prevention of Peritonitis in Children on Peritoneal Dialysis

2000 ◽  
Vol 20 (6) ◽  
pp. 625-630 ◽  
Author(s):  
Enrico Verrina ◽  
Masataka Honda ◽  
Bradley A. Warady ◽  
Beth Piraino
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Antibiotic Prophylaxis ◽  
Catheter Insertion ◽  
Catheter Removal ◽  
Training Period ◽  
Invasive Procedures ◽  
Exit Site ◽  
Experienced Surgeon ◽  
Considerable Body

We reviewed methods of preventing peritonitis in children. A considerable body of evidence indicates that peritonitis rates are lowest with the use of a double-cuffed catheter, with a downward directed tunnel, placed by an experienced surgeon. Evidence in adults, but lacking in children, suggests that exit-site mupirocin will lower Staphylococcus aureus exit-site infections and thus peritonitis rates. The risk of peritonitis due to contamination can be diminished by the avoidance of spiking and by the provision of a long training period. Catheter removal and replacement for catheter-related peritonitis may be done simultaneously in certain circumstances and is useful in decreasing the risk of recurrent peritonitis. Antibiotic prophylaxis at the time of catheter insertion, for contamination, during dialysate leaks, and for invasive procedures appears to be useful in diminishing peritonitis risk.

scholarly journals Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

2018 ◽  
Vol I (1) ◽  
pp. 06-11
Author(s):  
Andries Ryckx
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
P Value ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Infracolic Omentectomy

Introduction Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement. Materials and Methods A prospective database of patients with CAPD catheter placement from March 2004 to March 2015 was analyzed. All procedures were performed laparoscopically assisted and under general anesthesia by a single surgeon. 78 patients were included, there were no exclusion criteria. Statistical analysis was performed with SPSS. Fisher exact test and log-rank test with calculation of P-value was executed. P-value of <0.05 was considered significant. Results Of the 78 patients who underwent catheter placement, 53 (68%) were males and 25 (32%) were females. The mean age was 54 (ranged from 13 to 88 years). Selective infracolic omentectomy was performed in 32 patients if the momentum reached beyond the promontory. Non-resorbable sutures to fix the catheter were applied in 33 patients. The average duration of peritoneal dialysis was 21 months (range from ten days to 84 months). Omentectomy significantly reduced the incidence of catheter obstruction (3 vs. 11%, P=0.028) but not of catheter dislocation (19 vs. 30%, P=0.101). Omentectomy did not significantly increase the incidence of peritonitis (22 vs. 31%,P=0.133) or exit-site infection (16vs 17%, P=0.238). Catheter fixation with non-resorbable sutures reduced catheter dislocation (21 vs. 23%, P=0.226) and catheter obstruction( 12 vs.17%,P=0.223) with a significant reduction of peritonitis (15 vs. 29%, P=0.044) and no effect on exit-site infection (15 vs. 17%,P=0.251). Conclusion Laparoscopic PD catheter placement with selective omentectomy and fixation of the catheter to the abdominal wall is safe and feasible and leads to fewer complications. Key words: peritoneal, dialysis, catheter, complications, laparoscopy, omentectomy.

scholarly journals Peritoneal dialysis catheter insertion surgery and management

2018 ◽  
Vol 20 (1_suppl) ◽  
pp. 97-99
Author(s):  
Kazunari Yoshida ◽  
Daisuke Ishii
Keyword(s):  
Peritoneal Dialysis ◽  
Invasive Surgery ◽  
Catheter Insertion ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Less Invasive Surgery ◽  
Exit Site ◽  
Less Invasive ◽  
Access Surgery ◽  
Dialysis Discontinuation

Peritoneal access surgery is the first step to achieve successful peritoneal dialysis. It is important to perform easy, safe, and less invasive surgery of peritoneal dialysis catheter insertion. Secure peritoneal dialysis catheter insertion will lead to less infection, that is, exit site, tunnel infection, and peritonitis, which sometimes result in peritoneal dialysis discontinuation. To avoid these undesirable results, we should perform good and proper peritoneal dialysis insertion surgery. In this article, we describe peritoneal dialysis catheter insertion surgery and its management.

scholarly journals A Simple Tenckhoff Catheter Placement Technique for Continuous Ambulatory Peritoneal Dialysis (CAPD) Using the Bandung Method

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jonny ◽  
Rudi Supriyadi ◽  
Rully Roesli ◽  
Goh Bak Leong ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Developing Countries ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Cost Effective ◽  
Catheter Insertion ◽  
Catheter Removal ◽  
Seldinger Technique ◽  
Invasive Technique ◽  
Tenckhoff Catheter ◽  
Stage Renal Disease

Insertion of Tenckhoff catheters for continuous ambulatory peritoneal dialysis by nephrologists remains uncommon in most developing countries, including Indonesia. The aim of this study is to describe our experience on a simple technique of Tenckhoff catheter insertion by a nephrologist called the Bandung method. We conducted a retrospective observational study from May 2012 until December 2018 in 230 patients with end-stage renal disease using the Bandung method, a blind percutaneous insertion approach modified from the Seldinger technique. Early complications after insertion were assessed. The mean age of patients was 47.28 years (range 14–84 years). Within 1 month after insertion, complications occurred in 34 patients: 13 (5.7%) malposition, 8 (3.5%) omental trapping, 6 (2.6%) outlow failure, 3 (1.3%) peritonitis, 1 (0.4%) catheter infections, 1 (0.4%) bleeding, 1 (0.4%) kinking, and 1 (0.4%) hernia. None of these complications led to catheter removal. One patient experienced a late (>1 month) post-insertion complication of malposition that could not be repositioned and led to catheter removal. The Bandung method is a simple, cost effective, and minimally invasive technique for Tenckhoff catheter insertion that is associated with the same rate of complications compared to other techniques. This technique may useful for application in developing countries.

Infection Prophylaxis in Peritoneal Dialysis Patients: Results from an Australia/New Zealand Survey

2017 ◽  
Vol 37 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Denise J. Campbell ◽  
David W. Mudge ◽  
Martin P. Gallagher ◽  
Wai Hon Lim ◽  
Dwaraka Ranganathan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
New Zealand ◽  
Antifungal Prophylaxis ◽  
Catheter Insertion ◽  
Infection Prophylaxis ◽  
Infection Rates ◽  
Clinical Practices ◽  
Tenckhoff Catheter ◽  
Mupirocin Ointment ◽  
End Stage

BackgroundClinical practice guidelines aim to reduce the rates of peritoneal dialysis (PD)-related infections, a common complication of PD in end-stage kidney disease patients. We describe the clinical practices used by Australian and New Zealand nephrologists to prevent PD-related infections in PD patients.MethodsA survey of PD practices in relation to the use of antibiotic and antifungal prophylaxis in PD patients was conducted of practicing nephrologists identified via the Australia and New Zealand Society of Nephrology (ANZSN) membership in 2013.ResultsOf 333 nephrologists approached, 133 (39.9%) participated. Overall, 127 (95.5%) nephrologists prescribed antibiotics at the time of Tenckhoff catheter insertion, 85 (63.9%) routinely screened for nasal S. aureus carriage, with 76 (88.4%) reporting they treated S. aureus carriers with mupirocin ointment. Following Tenckhoff catheter insertion, 79 (59.4%) prescribed mupirocin ointment at the exit site or intranasally, and 93 (69.9%) nephrologists routinely prescribed a course of oral antifungal agent whenever their PD patients were given a course of antibiotics.ConclusionsAlthough the majority of nephrologists prescribe antibiotics at the time of Tenckhoff catheter insertion, less than 70% routinely prescribe mupirocin ointment and/or prophylactic antifungal therapy. This variation in practice in Australia and New Zealand may contribute to the disparity in PD-related infection rates that is seen between units.

scholarly journals Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis

2018 ◽  
Vol 38 (3) ◽  
pp. 163-171 ◽  
Author(s):  
Badri M. Shrestha ◽  
Donna Shrestha ◽  
Avneesh Kumar ◽  
Alice Shrestha ◽  
Simon A. Boyes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peritoneal Dialysis ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Advanced Laparoscopy

BackgroundThe optimal methodology of establishing access for peritoneal dialysis (PD) remains controversial. Previously published randomized controlled trials and cohort studies do not demonstrate an advantage for 1 technique over another. Four published meta-analyses comparing outcomes of laparoscopic versus open PD catheter (PDC) insertion have given inconsistent conclusions and are flawed since they group basic and advanced laparoscopy together. The aim of this systematic review and meta-analysis is to examine whether advanced laparoscopic interventions consisting of rectus sheath tunneling and adjunctive procedures produce a better outcome than open insertion or basic laparoscopy used only to verify the catheter position.MethodsA literature search using Medline, Embase, and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software (Nordic Cochrane Centre, The Cochrane Collaboration, London, UK). Outcomes evaluated incidence of catheter obstruction, migration, pericannular leak, hernia, infectious complications (peritonitis and exit-site infection) and catheter survival.ResultsOf the 467 records identified, 7 cohort studies, including 1,045 patients, were included in the meta-analysis. When advanced laparoscopy was compared with open insertion, a significant reduction was observed in the incidence of catheter obstruction (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.03 – 0.63; p = 0.01), catheter migration (OR 0.12, 95% CI 0.06 – 0.26; p = 0.00001), pericannular leak (OR 0.27, 95% CI 0.11 – 0.64; p = 0.003), and pericannular and incisional hernias (OR 0.29, 95% CI 0.09 – 0.94; p = 0.04), as well as better 1- and 2-year catheter survival (OR 0.52, 95% CI 0.28 – 0.97; p = 0.04 and OR 0.50, 95% CI 0.28 – 0.92; p = 0.03, respectively). Compared with basic laparoscopy, catheter obstruction and migration were significantly lower in the advanced laparoscopic group, whereas catheter survival was similar in both groups. All outcomes, except catheter obstruction, were similar between the basic laparoscopy and open insertion. The infectious complications such as peritonitis and exit-site infections were similar between the 3 groups.ConclusionsAdvanced laparoscopy was associated with a significant superior outcome in comparison with open insertion and basic laparoscopy.

A Randomized Trial Comparing Conventional Swan-Neck Straight-Tip Catheters to Straight-Tip Catheters with An Artificial Subcutaneous Swan Neck

2009 ◽  
Vol 29 (3) ◽  
pp. 278-284 ◽  
Author(s):  
Chiu-Leong Li ◽  
Tai-Gen Cui ◽  
Hong-Bing Gan ◽  
Kin Cheung ◽  
Weng-In Lio ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Controlled Trial ◽  
Good Alternative ◽  
Peritoneal Dialysis Catheter ◽  
Safe Procedure ◽  
Exit Site ◽  
Exit Site Infection ◽  
Tenckhoff Catheter ◽  
Post Surgery ◽  
The Difference

Objective To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck. Design Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting. Patients and Methods Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding. Results A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy. Conclusions Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.

Catheter Configuration and Outcome in Patients on Continuous Ambulatory Peritoneal Dialysis: A Prospective Comparison of Two Catheters

1994 ◽  
Vol 14 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Björn H. Eklund ◽  
Eero O. Honkanen ◽  
Aino-Riitta Kala ◽  
Lauri E. Kyllönen
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Infectious Complications ◽  
University Hospital ◽  
Exit Site ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Prospective Comparison ◽  
Catheter Tip ◽  
The Impact

Objective To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit-site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized trial. Setting CAPD unit in one university hospital. Patients Forty consecutive patients requiring a dialysis catheter for future CAPD were randomized to receive either a single-cuff straight Tenckhoff catheter or a permanently bent single-cuff Swan neck catheter. The skin exit was upward-directed in the Tenckhoff group and downward-directed in the Swan neck group. Results Dialysate leak occurred in one patient and symptomatic catheter tip migration in 3 patients with the Tenckhoff catheter but in none with the single-cuff Swan neckcatheter(p=O.5, p=0.12). No significant differences in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections could be demonstrated. Conclusion Catheter configuration did not influence the catheter-related mechanical or infectious complications. We were unable to demonstrate any advantage of the newer, permanently bent single-cuff Swan neck catheter over the conventional straight type.

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