Preperitoneal tunneling-a novel technique in peritoneal dialysis catheter insertion

Quality of life and nutritional status in peritoneal dialysis patients: a cross-sectional study from Palestine

BACKGROUND

End-stage renal disease (ESRD) is a growing cause of morbidity worldwide. Protein malnutrition is common among patients with ESRD. Peritoneal dialysis (PD) offers greater lifestyle flexibility and independence compared to the widely used treatments for ESRD. This study aimed to assess the nutritional status and the quality of life (QOL) of Palestinian patients undergoing PD, as well as the variables affecting these two outcomes.

METHODS

A cross-sectional study was conducted on patients receiving PD at An-Najah National University Hospital, Palestine. The malnutrition-inflammation scale (MIS) was used to measure malnutrition, and the QOL score was evaluated using the Dutch WHOQOL-OLD module. Univariate and multivariate linear regressions were performed to check the association between the QOL and MIS scores.

RESULTS

The study included 74 patients who were undergoing PD, with an average age of 50.5 ± 16.38. The majority of the patients were females. The study found a significant correlation between malnutrition and lower quality of life (QOL) scores, as measured by the WHOQOL-OLD questionnaire (p < 0.001). Furthermore, younger patients and those who had an occupation were more likely to report a good QOL (p = 0.01). Conversely, patients with pitting edema and diabetes were at higher risk of reporting a lower QOL (p < 0.001).

CONCLUSIONS

Given the elevated risk of malnutrition and diminished QOL among elderly patients, those with pitting edema, and individuals with diabetes, it is imperative to conduct thorough assessments for these groups. We strongly recommend that general practitioners, dietitians, and specialists collaborate to develop tailored programs and interventions to provide these patients with the focused care and attention they require.

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

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.

Combined fluoroscopic- and sonographic-assisted Tenckhoff catheter insertion for patients with previous intraperitoneal surgery

BACKGROUND

Tenckhoff catheter (TC) insertion for patients with previous intraperitoneal surgery (IPS) is challenging.

METHODS

This is a case series of 11 patients with history of previous IPS who underwent TC insertion under combined fluoroscopic and sonographic (CFS) guidance with preperitoneal tunneling at our center.

RESULTS

This is an interim result of our study. The mean age of the patients was 49.1 (±12.7). Seven were females, and four were males. Only two patients underwent more than one IPS prior to this procedure. The mean body mass index (BMI) of patients was 29.2 kg/m² (±6.2). All patients underwent the procedure successfully. One patient developed post-procedure exit site bleeding which resolved spontaneously. One patient had urgent-start peritoneal dialysis (PD) (less than 72 h), and two patients had early-start PD (less than 2 weeks). Median catheter survival is 8 months at the time of writing.

CONCLUSION

CFS-assisted TC insertion with preperitoneal tunneling for patients with previous IPS is a safe and effective technique.

Laparoscopic preperitoneal tunneling technique using a novel device for peritoneal dialysis catheter placement

BACKGROUND

We aimed to introduce the puncture technique based on a novel device for preperitoneal tunneling in laparoscopic PD catheter placement and to evaluate the safety and efficacy of this technique.

METHODS

This novel device was used in our center from May 2016. We conducted a retrospective analysis of patients undergoing laparoscopic PD catheter placement. The traditional method was performed in 20 patients and the novel procedure in 18 patients. A straight Tenckhoff PD catheter was placed in all patients.

RESULTS

No intraoperative complications were encountered in both groups. Compared the traditional technique group, the procedure based on the novel device had a shorter operative time (49.2 ± 11.8 vs 53.9 ± 12.5). One patient in the traditional tunneling group underwent catheter obstruction. There were no pericatheter leakage, exit site and subcutaneous infection, hernia and peritonitis in the early postoperative days. No mortality was observed in these patients. The 6-month survival rate of the catheter was 100%.

CONCLUSIONS

Laparoscopic preperitoneal tunneling technique is an effective way to implant intra-abdominal catheter. Our method based on a novel puncture device for preperitoneal tunneling is safe and efficient.

Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis

BACKGROUND

The optimal methodology of establishing access for peritoneal dialysis (PD) remains controversial. Previously published randomized controlled trials and cohort studies do not demonstrate an advantage for 1 technique over another. Four published meta-analyses comparing outcomes of laparoscopic versus open PD catheter (PDC) insertion have given inconsistent conclusions and are flawed since they group basic and advanced laparoscopy together. The aim of this systematic review and meta-analysis is to examine whether advanced laparoscopic interventions consisting of rectus sheath tunneling and adjunctive procedures produce a better outcome than open insertion or basic laparoscopy used only to verify the catheter position.

METHODS

A literature search using Medline, Embase, and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software (Nordic Cochrane Centre, The Cochrane Collaboration, London, UK). Outcomes evaluated incidence of catheter obstruction, migration, pericannular leak, hernia, infectious complications (peritonitis and exit-site infection) and catheter survival.

RESULTS

Of the 467 records identified, 7 cohort studies, including 1,045 patients, were included in the meta-analysis. When advanced laparoscopy was compared with open insertion, a significant reduction was observed in the incidence of catheter obstruction (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.03 - 0.63; p = 0.01), catheter migration (OR 0.12, 95% CI 0.06 - 0.26; p = 0.00001), pericannular leak (OR 0.27, 95% CI 0.11 - 0.64; p = 0.003), and pericannular and incisional hernias (OR 0.29, 95% CI 0.09 - 0.94; p = 0.04), as well as better 1- and 2-year catheter survival (OR 0.52, 95% CI 0.28 - 0.97; p = 0.04 and OR 0.50, 95% CI 0.28 - 0.92; p = 0.03, respectively). Compared with basic laparoscopy, catheter obstruction and migration were significantly lower in the advanced laparoscopic group, whereas catheter survival was similar in both groups. All outcomes, except catheter obstruction, were similar between the basic laparoscopy and open insertion. The infectious complications such as peritonitis and exit-site infections were similar between the 3 groups.

CONCLUSIONS

Advanced laparoscopy was associated with a significant superior outcome in comparison with open insertion and basic laparoscopy.

Respecting shape memory to optimize peritoneal dialysis catheter outcomes

Disruption of the shape memory of a peritoneal dialysis catheter at the time of insertion may be a factor responsible for tip migration and catheter dysfunction. The use of postimplantation radiology to confirm the preservation of both the swan neck angle and the inclination angle may have a role in standardizing insertion technique with the potential to reduce the impact of operator variation on catheter outcomes.