A Brief Recap of Tips and Surgical Manoeuvres to Enhance Optimal Outcome of Surgically Placed Peritoneal Dialysis Catheters

Abstract

<jats:p><jats:italic>Background</jats:italic>. Peritoneal dialysis (PD) is an effective option of renal replacement therapy for ESRF, offering advantages over haemodialysis. Peritoneal dialysis catheter (PDC) placement is thought to be the key to successful PD and the economic advantages are lost if a patient switches to HD in the 1st year. This paper is a brief document elaborating a recap of published literature, looking at various surgical tips and manoeuvres to enhance optimal outcome of PDC placement.<jats:italic>Methods</jats:italic>. A search strategy assessing for access team, preoperative antibiotic prophylaxis, type of catheter, catheter exit site, intraoperative catheter trial, optimal time to commence PD, hernia repairs, number of cuffs, catheter-embedding procedures, rectus sheath tunnelling, laparoscopic fixing, omentopexy, omentectomy, the “Y”-Tec system, resection of epiploic appendages, adhesiolysis, a trained surgeon, and perioperative catheter care protocol was used looking at various databases.<jats:italic>Findings</jats:italic>. The complications of catheterrelated dysfunction can be reduced with advanced planning of access placement, immaculate surgery, and attention to catheter insertion techniques.<jats:italic>Conclusion</jats:italic>. The success of a peritoneal dialysis programme depends upon functional and durable long term access to the peritoneal cavity; this depends on placement techniques and competent surgeons and psychosocial support to the patient. The various technical tips and manoeuvres elaborated here should be considered options carried out to improve outcome and reduce catheter dysfunction.</jats:p>

Guidelines for laparoscopic peritoneal dialysis access surgery

“…This usually requires another trocar to place the suture. There have been, however, reports of suture fixation preventing easy catheter removal as well as being a potential cause of internal hernia or adhesions [126]. It may also impair the natural ability of the catheter to ''float'' to the largest area of PD fluid.…”

“…He showed 12 % migration rate with open and none with laparoscopic, although the dysfunction rates were 4 and 6 %, respectively [112]. In a review article by Frost et al, it was recommended that ''proper rectus sheath tunneling and placement of the deep cuff are the key to reducing catheter tip migration'' (not suture fixation) [126]. However, randomized trials comparing catheter insertion with and without suture fixation or comparing suture fixation to rectus sheath tunneling have not been performed.…”

Type of Peritoneal Dialysis Catheter and Outcomes

“…Although a curled tip catheter has been considered by some clinicians as more likely to remain within the pelvis, offering a better drainage than a straight tip catheter (19, 20), no clear evidence supports this common belief. In 2011, Xie et al (21) compared the clinical outcomes of coiled vs. straight-end swan neck PD catheters in a prospective randomized controlled trial of 80 patients.…”

Reduction or Discontinuation of Antibiotic Prophylaxis in Vascular Access Surgery, Tendon Sheath Incision and PD Catheter Placement

“…In particular, prophylactic methods for central venous catheter-related infections, dental work and colonoscopies have been well-established (46–9) and economically analyzed (10, 11). However, only a few studies have reported the effect of judicious use of antibiotics in minor surgeries for dialysis patients (12). In particular, discontinuation of antibiotics in arteriovenous fistula (AVF) and tendon sheath incision surgeries has yet to be investigated.…”