New peritoneal catheters: new catheter problems?

A simple modified open peritoneal dialysis catheter insertion procedure reduces the need for secondary surgery

BACKGROUND

The aim of this retrospective study was to assess the efficacy of a modified peritoneal dialysis catheter insertion technique for reducing the incidence of mechanical complications.

METHODS

We conducted a retrospective analysis of clinical data of 346 patients undergoing peritoneal dialysis catheter insertion at our peritoneal dialysis center. The traditional procedure was performed in 157 patients (group A) and the modified procedure in 189 patients (group B). The double-polyester-cuff straight Tenckhoff catheter was used in all patients.

RESULTS

At the end of 1 year, tunnel inflammation was more common in group A (21 patients after 0.011 patient-months follow-up versus 10 patients in group B after 0.007 patient-months of follow-up; p = 0.009). Technical survival rate of the catheter was significantly higher in group B (97.35% in group B vs. 89.81% in group A; p = 0.005). All-cause mortality was not significantly different between the two groups (4.5% in group A vs. 3.2% in group B; p = 0.532). Postoperative mechanical complications were also higher in group A (32 patients [20.4%] in group A vs. 3 patients [1.6%] in group B; p < 0.001). The incidences of complications such as hernia, dialysis fluid leakage, hemorrhage, incision infection, and prolapse of the polyester cuff were similar in the two groups.

CONCLUSION

The simple modified peritoneal dialysis catheter insertion procedure decreases the occurrence of catheter migration andomental encapsulation and improves the technical survival rate of the catheter.

Obstrucción mecánica de colon producida por un catéter autoposicionante de diálisis peritoneal

Introdución: El catéter peritoneal resulta imprescindible para la realización de la diálisis peritoneal. Se han desarrollado distintos modelos y en 1996 apareció el catéter Autoposicionante con la intención de disminuir las disfunciones por desplazamiento gracias al peso de tungsteno de su extremo. Esta complicación condiciona su funcionamiento y la viabilidad de la técnica. CASO CLÍNICO: Presentamos el caso de un varón al que se coloca catéter Swan Neck con funcionamiento inicial bueno, pero que en tres meses necesita dos maniobras alfa por migraciones y termina precisando recambio de catéter, colocándose en esta ocasión un catéter Autoposicionante. Ya durante el periodo de cicatrización presenta nuevo desplazamiento y una tercera maniobra alfa permite reiniciar la técnica. A los tres meses ingresa para estudios por clínica abdominal; en la radiografía de abdomen se observa dilatación de asas, el TAC urgente muestra dilatación de ciego y colon hasta el cruce con el catéter de diálisis peritoneal, llegándose al diagnóstico de obstrucción mecánica de colon por catéter de diálisis. Se realiza laparoscopia y se recoloca la punta en la pelvis. Tras la cirugía el paciente evoluciona favorablemente y a los tres meses recibe trasplante renal de cadáver. A pesar optar por el catéter autoposicionante debido a su menor tasa de desplazamientos, en el caso de nuestro paciente se repite el episodio y además se asocia a una complicación grave.

Laparoscopic treatment of large bowel obstruction due to a self-locating peritoneal dialysis catheter

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Intestinal obstruction due to self-locating peritoneal dialysis catheters is an infrequent condition.

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A 55-year-old patient diagnosed with large bowel obstruction was successfully treated by laparoscopic approach.

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The weight added to the tip of self-locating catheters can cause different complications, including decubitus ulcers or perforations of soft tissues.

Introduction

Peritoneal dialysis has been used in the treatment of end-stage renal disease for a long time. The development of continuous ambulatory peritoneal dialysis (CAPD) has achieved an acceptable device of renal replacement therapy.

Presentation of case

We report a 55 year-old patient who was initiated on CAPD in February 2016. Three months later, the Tenckhoff catheter was removed due to its malfunction, and a new self-locating peritoneal dialysis catheter was placed in the left side of the abdomen. In September 2016, the patient presented with symptoms of intestinal obstruction. A CT scan revealed a collapsed sigmoid colon with the tungsten tip of the catheter supported on the mesosigmoid as the cause of the occlusion.

Discussion

Herein, a rare but clinically important case of mechanical large bowel obstruction due to self-locating peritoneal dialysis catheter is presented. The weight added to the tip of the self-locating catheter for the purpose of stretching it, can be dangerous if a displacement takes place. A laparoscopic procedure was performed, resolving the obstruction by reinserting the peritoneal catheter in its right position.

Conclusion

The weight added to the tip of self-locating catheters is a matter of concern, since intimate contact between the peritoneal catheter and the intestinal wall can result in perforation or intestinal occlusion.

Introduction of a new laparoscopic trocar for insertion of peritoneal dialysis catheters and making a proper rectus sheath tunneling

BACKGROUND

Using a proper laparoscopic trocar for making a downward rectus sheet tunneling (RSHT) during the implementation of peritoneal dialysis (PD) catheters leads to a longer survival of catheter and less catheter dysfunction. As no specific laparoscopic trocar has been invented for insertion of PD catheters, we designed a new trocar. In this article, we describe specifications of our new invented trocar for the first time. We will describe our experience with it in our patients as well.

METHODS

The new stainless steel trocar includes a cannula and a mandarin. The cannula consists of a tube pipe and head. The tube pipe is so long that is proper for rectus sheet tunneling, and its internal diameter is fitted for easy passage of the catheter with its cuffs. The head consists of two steel parts holding a unidirectional plastic valve preventing backflow of the air. The mandarin section includes a sharp shaft and a metal cap. The distal end of the mandarin is an atraumatic conical tip which was designed to make a safe RSHT.

RESULTS

A total of 30 PD catheters were successfully implanted through 30 laparoscopic procedures in 12 males and 18 females (mean age 48.16 ± 14.18 years). All catheters were successfully inserted without any intraoperative complication. Exit-site infection, peri-catheter leakage, and outflow failure were found in two, one, and one patient, respectively. We did not find any inflow failure, catheter malpositioning, migration, or kinking. No other complication was observed during the 1-year follow-up period.

CONCLUSION

The new designed PD trocar is a proper port for laparoscopic implantation of the peritoneal dialysis catheter. It is a safe and easy handle trocar that helps surgeons to make an appropriate rectus sheath tunneling with minimal complications.