Modified Simple Peritoneal Wall Anchor Technique (Pwat) in Peritoneal Dialysis

Abstract

♦ BACKGROUND: Outflow obstruction, a common complication in patients with peritoneal dialysis (PD), usually results in unnecessary catheter removal or replacement. This study describes a modified simple method of anchoring a PD catheter on the anterior peritoneal wall without using a laparoscopic system (peritoneal wall anchor technique, PWAT). ♦ METHODS: We performed a retrospective cohort study of consecutive PD catheter insertions, and compared the catheter survival rate between the traditional method and the modified simple PWAT. The traditional method was used in 54 cases and the modified simple PWAT was used in 17 cases. The primary endpoint was the occurrence of surgical catheter repair because of outflow obstruction by day 365. The secondary endpoint was the occurrence of catheter migration with obstruction requiring any interventions, including the alpha-replacement method by day 365. Catheter survival was analyzed by Kaplan-Meier survival curves. ♦ RESULTS: Migration-free catheter survival was significantly (p = 0.02) higher in the PWAT group (100%, 17/17) than in the traditional group (72.2%, 39/54). Catheter survival without surgical repair or cessation of PD was also significantly (p = 0.04) higher in the PWAT group (100%, 17/17) than in the traditional group (77.8%, 42/54). Similarly, migration-free and surgery-free catheter survival rates in cases with a straight-type catheter in the PWAT group were significantly higher than those in cases with a straight-type catheter in the traditional group. ♦ CONCLUSIONS: Our results suggest that the modified simple PWAT provides a better catheter survival rate than the traditional method by preventing catheter migration with obstruction in PD.

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

“…[19,20] However catheter migration is still a big problem in peritoneal dialysis catheter insertion and therefore in recent years catheter fixation to the abdominal wall have been developed to prevent this complication. [21][22][23] In various studies disadvantages of laparoscopic peritoenal dialysis catheter insertion was reported to be; long operative time, increased costs and risks due to need of general anesthesia. [24,25] Sedation, local anesthesia, general anesthesia and regional block have been the methods used during insertion.…”

How to Prevent Peritoneal Dialysis Catheter Tip Migration: A Japanese Perspective

“…The original method of PWAT requires laparoscopic assistance or a particular device named the PWAT applicator [22,23]. Recently, a simple modified PWAT, which does not require laparoscopic assistance or special devices has been established [24]. It was reported that the modified PWAT achieved a better catheter survival rate than the traditional method by preventing catheter tip migration [24].…”

Proposal of peritoneal biopsy procedures for patients undergoing peritoneal dialysis

“…At our institution, the PD catheter is inserted at a point 3 cm cranial to the biopsy area and is then fixed to the abdominal wall using a 2-0 nylon suture under vision from the biopsy area (peritoneal wall anchor technique) ( Fig. 2g-i) [11]. The peritoneal wall anchor technique reportedly improves the catheter survival rate [10], although the catheter is blindly fixed to the abdominal wall at the area inferior to the catheter insertion in the absence of peritoneal biopsy.…”

“…The peritoneal wall anchor technique reportedly improves the catheter survival rate [10], although the catheter is blindly fixed to the abdominal wall at the area inferior to the catheter insertion in the absence of peritoneal biopsy. However, in addition to the aforementioned advantage [11], the present method employing biopsy area allows for the fixation of the catheter to the abdominal wall in a safe and simple manner.…”