Preperitoneal Tunneling – a Novel Technique in Peritoneal Dialysis Catheter Insertion

Abstract

The catheter problems regardless of placement technique are variable as 2 to 31% for flow dysfunction and catheter displacement (1,2) and 1 to 27% for pericatheter leak and hernia (3,4). The most common causes of catheter dysfunction are migration, fibrin clot and omental wrapping (5).Insertion of PDC under direct visualization by laparoscopy affords a number of advantages including decreased operating time, less perioperative pain and fewer complications compared to an open surgical approach (6,7). Various laparoscopic techniques have been described for catheter placement to reduce complications and improve results (7-9). These efforts include rectus sheath tunneling, omentectomy, selective prophylactic omentopexy, catheter fixation by suturing and selective resection of epiploic appendices and adhesiolysis.The aim of this study is to present a novel technique for laparoscopic placement of PDC through a preperitoneal tunnel which can reduce complications and improve catheter survival. PaTIeNTs aND MeThoDsThis project was designed as a prospective interventional study, approved by the Research Committee and financially supported by the Research Deputy of Mashhad University of Medical Sciences. To reduce ambiguous results, we excluded patients who had a possibility of existing abdominal adhesion due to several abdominal operations, intestinal or urinary ostomy, or severe coagulopathies. With their informed consent, the patients were systematically examined. From

Sedation anesthesia technique for the insertion of laparoscopic fixated peritoneal dialysis catheter using carbondioxide

“…[24,25] Sedation, local anesthesia, general anesthesia and regional block have been the methods used during insertion. [4,6,7,13,16,17] Studies including local, sedation and regional blocks are very limitted and they have frequently used helium and nitrous oxide insufflation agents. [12,[26][27][28] Limitted use of other inter gases such as nitrous oxide and helium with respect to carbondioxde is a limitting factor in the use of sedation and local anesthesia techniques in laparoscopic peritoenal dialysis insertion modality.…”

“…[2,3] Therefore; laparoscopic implantation of the catheter have been popularized. [4][5][6][7] Unfortunately; laparoscopic procedures in general require application of the GA and majority of the patients with ESRD have concomitant systemic disease such as hypertension, diabetes mellitus, congestive heart failure and coronary artery disease that creates risk factors and limits the use GA. Recently; in order to prevent catheter malpositioning following laparoscopic catheter insertion certain fixation methods have been employed.…”

Respecting shape memory to optimize peritoneal dialysis catheter outcomes

“…4 Embellishments of the insertion technique have been described such as the use of preperitoneal tunneling in order to stabilize the intraperitoneal segment and reduce catheter migration. 5 Shape memory, or resilience force, is the ability of a material to resume an original configuration after applied forces such as pressure. Its importance for the placement of PD catheters was recognized by Twardowski and colleagues in the 1980s when they observed that the placement of straight Tenckhoff catheters using a curved rather than a straight subcutaneous tunnel sometimes resulted in extrusion of the external cuff.…”

“…4 However, it became quickly apparent that mutations to the gene are a rare cause of MODY. 5 Indeed, the HNF1b mutation detection rate has been reported as being as low as about 1% in MODY patients. But this rate rises to about 20% or about 40% in patients with renal structural abnormalities (RSAs) alone or RSAs plus MODY, respectively.…”

“…But this rate rises to about 20% or about 40% in patients with renal structural abnormalities (RSAs) alone or RSAs plus MODY, respectively. [5][6][7] Interestingly, renal phenotypes are not observed in other MODY types, reclassifying MODY5 as a new syndrome, renal cyst and diabetes syndrome (RCAD, OMIM 137920). In RCAD patients, renal disease severity can vary from asymptomatic cystic disease to renal abnormalities incompatible with life.…”