Surgical aspects of continuous ambulatory peritoneal dialysis — 3 years experience

Abstract

Since January 1979, 122 patients (mean age 38.5 years, range 5-72 years) with chronic renal failure have been treated with continuous ambulatory peritoneal dialysis (CAPD). Peritoneal access was achieved by inserting silicone rubber Tenckhoff peritoneal dialysis catheters (Quinton, Seattle, Washington) by an open (76 per cent) or closed technique. Actuarial analysis showed a patient survival of 98 and 94 per cent and a success rate of 88 and 64 per cent at 1 and 2 years, respectively. Currently, 74 patients are using CAPD and 8 have been treated for 30-36 months. Thirty-five patients (29 per cent) required two or more peritoneal catheters and 69 per cent of these patients are still on CAPD. Catheter-related peritonitis was the most frequent complication (233 separate episodes in 94 patients) and necessitated catheter removal in 16 per cent of episodes, although 37 per cent of patients from whom catheters were removed because of peritonitis later resumed CAPD. Extravasation of dialysate from the peritoneal cavity (31 episodes) and catheter obstruction (31 episodes) required surgical replacement of catheters in 8 and 23 cases, respectively. Twenty patients (16 per cent) developed 24 abdominal hernias, only one of which caused failure of CAPD. Infective and mechanical complications of CAPD frequently require surgical intervention but only occasionally result in failure of the technique, and even multiple catheter replacements are compatible with successful long term CAPD.

Percutaneous Peritoneal Dialysis Catheter Insertion by a Nephrologist: A New, Simple, and Safe Technique

“…The incidence of catheter-related malfunction in the literature varies from 0.9% to 17% for surgical (19)(20)(21)(22)(23)(24)(25)(26)(27)(28) and 4% to 21% for percutaneous studies (1,(7)(8)(9)(16)(17)(18). Although it has been argued that surgical catheter placement is preferable to percutaneous placement because of direct visualization during positioning (29), several studies have shown that surgical placement holds no advantage in regard to catheter-related malfunction (5,9). Our data support that view: We observed diminished outflow in 12.5% of catheters (corrected by repositioning), an incidence comparable to the rate seen in percutaneous studies.…”

Complications with Permanent Peritoneal Dialysis Catheters: Experience with 154 Percutaneously Placed Catheters

“…It has been argued that surgical catheter placement is pref erable to percutaneous placement because the catheter tip is positioned under direct visualization [10], However, in a prospective comparative study, one-way obstruction to flow was encountered in 17.5% of surgically placed Tenckhoff catheters and 16.2% of percutaneously placed catheters [9], with no significant difference between the two methods.…”

“…The latter solution, though, not only predisposes to obstruction of the catheter with fibrin clots, but may also necessitate acute hemodialysis during the time that peritoneal dialy sis is withheld. Persistent leaks require catheter replace ment in some patients [2,10]. The percutaneous approach, by puncturing and dilating the peritoneum, without incis ing it, may minimize the chance of developing a leak.…”

“…Distension of the peritoneal cavity with fluid predisposes to leaks until the incision has healed. To prevent leaks, nephrologists have tried using small-volume passes ini tially [9,10], or even withholding dialysis completely for the first few days after catheter insertion [6]. The latter solution, though, not only predisposes to obstruction of the catheter with fibrin clots, but may also necessitate acute hemodialysis during the time that peritoneal dialy sis is withheld.…”

“…Most published series have re ported the results of surgically placed catheters involving incision of the peritoneum and direct visualization of the peritoneal space [1][2][3][4][5][6][7][8][9][10]. The 'surgical method' suffers from two disadvantages: the necessity for operating room time and the requirement of a large abdominal incision.…”