A Modified Open Surgery Technique for Peritoneal Dialysis Catheter Placement Decreases Catheter Malfunction

Abstract

ORIGINAL ARTICLES♦The modified surgery was characterized by a low incision site, a short intra-abdominal catheter segment and an additional upward straight subcutaneous tunnel. All patients were followed up for 2 years or until death. Survival rates, complications caused by catheter placement, and the probability of malfunction-free catheter survival were compared between the groups. ♦ Results: Catheter malfunction was the most frequent mechanical complication, found in 31 patients (14.4%), who experienced 38 malfunctions. Only 2 episodes of catheter malfunction were found in the MO-S group, representing a rate significantly less than those in the TO-S and TO-C groups (both p < 0.05). Kaplan-Meier curves for malfunctionfree PD catheter survival showed a significantly different malfunction-free probability for the various groups (p = 0.009). After 2 years of follow-up, 136 patients (63.0%) survived with their initial PD catheter. The initial catheter survival rate was 76.8% in the MO-S group. Kaplan-Meier curves for initial catheter survival showed that the highest survival rate was found in the MO-S group (p = 0.001). ♦ Conclusions: The modified open surgery technique is a reliable method for catheter placement.

Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction

“…8,11,14,15 As a result, we developed a modified open surgery technique with a lower implant position (7 cm above the pubic symphysis), a shorter intra-abdominal catheter segment, and a long, straight, upward subcutaneous tunnel in our previous work, which was demonstrated to promisingly decreased the incidence of catheter malfunction (3.57%). 5 The advantages of this method are confirmed again in the present study with an incidence of catheter malfunction of 4.08%, significantly lower than that of the traditional open surgery group. However, there were still patients underwent catheter malfunction and repeated operation were needed.…”

“…The procedure of modified open surgery has been described in detail in our previous work. 5 The main differences between modified open surgery and traditional open surgery are as follows: (i) a lower position of catheter implantation: 7 cm above the pubic symphysis and 2 cm lateral to the midline; (ii) a shorter length of intra-abdominal catheter section which was set during operation based on a real-time measurement of the distance between the peritoneal opening and the Douglas or rectovesical pouch. In brief, after a purse string suture was placed in the peritoneum, the catheter was inserted into the Douglas or rectovesical pouch.…”

“…However, there were still patients suffering from catheter tip migration and obstruction. 5 In this study, we further improved the above method by fixing the intra-abdominal part of the catheter to the lower abdominal wall, which is proved to be a simple, economical and effective procedure with lower incidence of catheter malfunction and better survival rate.…”

“…Our previous study indicated that a modified catheter placement method characterized by a low incision site, a short intra‐abdominal catheter segment and an additional upward straight subcutaneous tunnel can significantly decrease the incidence of catheter malfunction. However, there were still patients suffering from catheter tip migration and obstruction . In this study, we further improved the above method by fixing the intra‐abdominal part of the catheter to the lower abdominal wall, which is proved to be a simple, economical and effective procedure with lower incidence of catheter malfunction and better survival rate.…”

An analysis of the “Half-Perc” versus open surgical placement method for a peritoneal dialysis catheter: a non-inferiority cohort study

“…The regular PD program was usually started at 7 days after catheter insertion [25,26]. However, the timing of PD catheter implantation was relatively late and the initiation of PD was early in China since most ESRD patients needed urgent dialysis treatment.…”