Importance of the creation of a short musculofascial tunnel in peritoneal dialysis catheter placement

Abstract

BACKGROUND Peritoneal dialysis (PD) catheter migration impedes the efficacy of dialysis. Therefore, several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis. AIM To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation. METHODS Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study. The patients were divided into two groups based on the procedure performed: Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017. We recorded patient characteristics and catheter complications over a two-year follow-up period. In addition, postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration. RESULTS The no-tunnel and tunnel groups included 115 and 107 patients, respectively. Compared to the no-tunnel group, the tunnel group showed lesser catheter angle deviation toward the pelvis (15.51 ± 11.30 vs 25.00 ± 23.08, P = 0.0002) immediately after the operation, and a smaller range of migration within 2 years postoperatively (13.48 ± 10.71 vs 44.34 ± 41.29, P < 0.0001). Four events of catheter dysfunction due to migration were observed in the no-tunnel group, and none occurred in the tunnel group. There was no difference in the two-year catheter function survival rate between the two groups (88.90% vs 84.79%, P = 0.3799). CONCLUSION The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration, thus preventing catheter dysfunction.