Interventional Nephrology and Dialysis: Three Purse‐String Sutures Allow Immediate Start of Peritoneal Dialysis with a Low Incidence of Leakage

Abstract

Peritoneal dialysis (PD) depends to a great extent on a well-functioning dialysis catheter. The number of patients choosing PD also depends on the possibility of starting dialysis with this technique without needing to use hemodialysis (HD) intermediate or in the beginning of the procedure. This review describes various insertion techniques focusing on a surgical insertion technique using purse-string sutures to fix the peritoneum around the catheter with the inner cuff of a Tenckhoff catheter invaginated between purse-string sutures of the peritoneal membrane and the inner rectus muscle fascia. A third purse-string suture is used to fix the catheter and to tighten the hole in the external rectus fascia. This technique enables immediate start of PD with only a limited risk for early and late leakage. Similar fixation sutures could be considered when inserting catheters, using other insertion modes, to tighten the hole and the position of the cuff and the catheter.

Impact of Break-In Period on the Short-Term Outcomes of Patients Started on Peritoneal Dialysis

“…Episodes of catheter dysfunction were not significantly different between BI 8-14 patients and BI >14 patients (p > 0.05). Patients in the BI ≤7 group were more likely to experience catheter malposition than were patients in the BI [8][9][10][11][12][13][14] group (3.5% vs 0.7%, p = 0.006); they also seemed to more often experience catheter malposition, but the difference in that variable did not reach statistical significance (3.5% vs 1.1% in BI >14 patients, p = 0.089). We observed no significant differences between the groups with respect to leaks, omental wrap, and obstruction (all p > 0.05).…”

“…Our study enrolled 657 patients (44.5% men), including 344 (52.4%) in the BI ≤7 group, 137 (20.9%) in the BI [8][9][10][11][12][13][14] group, and 176 (26.7%) in the BI >14 group. There were no significant differences between the groups with respect to sex, body mass index, treatment period, prevalence of polycystic kidney disease, comorbidities, past history of abdominal surgery, or use of steroids (all p > 0.05).…”

“…Crude technique survival at 6 months was 94% for BI ≤7 patients, 99% for BI [8][9][10][11][12][13][14] patients, and 98% for BI >14 patients. Technique survival was lower among BI ≤7 patients than among BI [8][9][10][11][12][13][14] patients (log rank: 5.438; p = 0.020) and BI >14 patients (log rank: 3.980; p = 0.046; Figure 1) In each group, the crude rates of patient survival at 6 months were 94% for BI ≤7 patients, 95% for BI [8][9][10][11][12][13][14] patients, and 99% for BI >14 patients. After adjustment for baseline characteristics, older age (HR: 1.027; 95% CI: 1.001 to 1.053; p = 0.043) and lower serum albumin (HR: 0.908; 95% CI: 0.842 to 0.980; p = 0.014) were both risk factors for 6-month patient mortality, but a break-in period of 7 days or less did not predict patient mortality during the first 6 months.…”

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

“…Reported leak rates are significantly lower for all documented laparoscopic series, even when catheters are used straight away [1, 34–38]. Purse string sutures at the cuff to anchor have been described during open surgery and do reduce the risk of early leaks [39, 40]. Yang et al, did not show higher risk of catheter-related problems in PD patients starting dialysis less than 2 weeks (earlier group (2.0 ± 2.7 days) versus late group (40.6 ± 42.8 days): 14.6% and 13.1%, resp.…”

The Choice of Peritoneal Dialysis Catheter Implantation Technique by Nephrologists

“…In our center, intermittent PD is performed in almost all patients immediately after implantation, and yet leakage is almost absent and catheter malfunction from other causes is also very uncommon [10, 37]. Excellent PDC outcomes have also been reported from other centers using minilaparotomy as the insertion technique by nephrologist [38–40]. To many nephrology services, the requirement of an operating room setting for minilaparotomy may be a limiting factor.…”