Peritoneal dialysis catheter insertion by surgical minilaparotomy: Outcome analysis between nephrologist and surgeon

Abstract

Surgical minilaparotomy technique of Tenckhoff catheter placement is rarely practiced by nephrologists. There is a scarcity of data comparing technique and outcomes of surgically inserted peritoneal dialysis catheters by surgeon and nephrologist. We retrospectively analyzed 105 Tenckhoff catheters inserted by surgical minilaparotomy (”S” [surgeon], n = 43 and “N” [nephrologist], n = 62) in end-stage renal disease. Comparative analysis of surgical technique, survivals, and complications between both groups was done. “N” group observed two major advantages; shorter break-in (P < 001) and early continuous ambulatory peritoneal dialysis rehabilitation. Cumulative catheter experience was 1749 catheter-months: 745 and 1004 catheter-months in “S” and “N” groups, respectively. “N” group had a better overall catheter and patient survival, and a statistically insignificant mechanical complications, seen mostly in obese and post-abdominal surgery patients, without fatality or catheter loss. Peritonitis rates (P = 0.21) and catheter removal due to refractory peritonitis (P = 0.81) were comparable. The technique used is practical and aids early break-in, yields better results, and later on, helps in easy and uncomplicated PDC removal as and when indicated. Mechanical complications, mostly bleeding, were managed conservatively without any catheter or patient loss. This method should be encouraged among nephrologists and nephrology residents.

Peritoneal dialysis catheter insertion by nephrologist using minilaparotomy: Do survival and complications vary in obese?

“…[ 6 7 8 9 10 ] Surgical minilaparotomy for PDC insertion was usually done by surgeons/urologists and very rarely by nephrologists. The data addressing the use of surgical minilaparotomy by interventional nephrologists for PDC insertion is scarce[ 12 13 14 15 ] and is further lacking for obese and overweight subset. Though percutaneous technique has been used for obese patients, elaborate studies are absent.…”

Comparison of peritoneal dialysis catheter insertion techniques by nephrologists: Surgical vs blind methods

“…The surgical method has been classically performed by surgeons, but PDC insertion using the surgical method has been performed by some nephrologists following additional training 3,4,20 . A previous study in an Indian population showed that there was no significant difference in results when the same technique was performed by surgeons or nephrologists 10 . Yang et al showed that PDC insertion by nephrologists using surgical method has a more favorable catheter outcome and are useful to rapidly growing PD centers 21 .…”

“…3,4,20 A previous study in an Indian population showed that there was no significant difference in results when the same technique was performed by surgeons or nephrologists. 10 Yang et al showed that PDC insertion by nephrologists using surgical method has a more favorable catheter outcome and are useful to rapidly growing PD centers. 21 Although our study did not evaluate the effect of PDC insertion by nephrologists for growing PD centers, both the quality and quantity of PD centers would be predicted to improve.…”

“…Recently, the use of a surgical method by nephrologists has also become popular. Indeed, Dogra et al showed comparable results for the surgical method performed by surgeons and nephrologists 10 . However, there are few studies that have compared the use of blind and surgical methods by nephrologists.…”

“…Indeed, Dogra et al showed comparable results for the surgical method performed by surgeons and nephrologists. 10 However, there are few studies that have compared the use of blind and surgical methods by nephrologists. The aim of the present study was to perform a comparative analysis of PDC insertion between blind and surgical methods by nephrologists.…”