Percutaneous and Surgical Insertion of Peritoneal Catheter in Patients Starting in Chronic Dialysis Therapy: A Comparative Study

Abstract

Percutaneous peritoneal catheter insertion can be performed by trained nephrologists. The objective of this study was to compare the outcome of peritoneal dialysis (PD) catheters percutaneous inserted with the traditional surgical technique. One hundred twenty-one PD catheters were placed in 121 stage-5 Chronic kidney disease patients using three techniques: percutaneous insertion (Group P, n = 53), percutaneous insertion guided by radioscopy (Group R, n = 26), and surgical insertion (Group S, n = 42). The mean age of the whole cohort was 57 ± 16 years and 54% were male. Patients and catheter outcomes were followed up prospectively for 19 months. Gender, age, body mass index, previous abdominal surgeries, and the prevalence of diabetes mellitus were not significantly different among the groups as well as the incidence of bleeding and the presence of catheter dysfunction. In addition, the incidence of exit-site infections and peritonitis was not significantly different among the groups. Finally, the survival catheter rate was not significantly different by the end of the follow-up of 19 months (70% in P group, 85% in R, and 70% in S group (log rank = 0.88, p = 0.95). The outcome of percutaneous implanted catheters, which were inserted by a trained nephrologist, did not demonstrate to be inferior as compared with the traditional surgical approach.

Ultrasound‐guided percutaneous peritoneal dialysis catheter insertion using multifunctional bladder paracentesis trocar: A modified percutaneous PD catheter placement technique

“…Moreover, the conventional Seldinger technique uses a blind puncture process, so it is difficult to place the catheter accurately and there is risk of organ injury and hemorrhage. Some studies have even found no advantages of percutaneous catheterization over traditional open surgery or laparoscopic surgery regarding catheter‐related complications and catheter survival duration, 12‐15 suggesting the need for further improvement.…”

“…Medani et al reported a 90% success rate, defined as maintenance of normal catheter function for 2‐4 weeks, using the blind Seldinger technique in patients receiving catheterization for the first time without a history of abdominal surgery, similar to that of a parallel surgical placement group 16 . However, van Laanen et al reported that only 77% of patients maintained normal catheter function for 2 weeks after surgical insertion (failure rate of 23%), 11 and several other randomized control trials have also reported relatively high (16% to 30%) failure rates for catheterization by surgical laparotomy 12‐14 . Thus, all the previous techniques show substantially greater failure rates (up to 30%) than ultrasound‐guided percutaneous peritoneal dialysis catheter placement using a multifunctional bladder paracentesis trocar (around 4% failure).…”

“…16 However, van Laanen et al reported that only 77% of patients maintained normal catheter function for 2 weeks after surgical insertion (failure rate of 23%), 11 and several other randomized control trials have also reported relatively high (16% to 30%) failure rates for catheterization by surgical laparotomy. [12][13][14] Infection is the main cause for catheter removal. 19 Although none of the patients in our study received antibiotics to prevent peritonitis, there were no such cases.…”

Evaluating the benefits of home-based peritoneal dialysis

“…Moreover, the success rate is similar to that of surgicallyinserted PD catheters. [27][28][29] Supine intermittent PD can be immediately started after PD catheter insertion, avoiding temporary HD.…”

Percutaneous Peritoneal Dialysis Catheter Placement in Patients with Complex Abdomen

“…After the initial reports of two perforation complications by blind trocar technique in 1991, presumably due to adhesions, standard practice was to exclude patients with complex abdomen from all percutaneous techniques (16). Since 2000, only one study by Chula et al reported patients undergoing percutaneous placement with complex abdomen (21% of patients) (17).…”