This article appears in the following NDT Plus issue: Dialysis Initiatives May 2007, Berlin, Germany [View the issue table of contents]
Peritoneal dialysis catheter placement technique and complications
1 Department of Surgery, University Hospital Maastricht
2 Department of Nephrology, VieCuri Hospital Venlo
3 Department of Nephrology, University Hospital Maastricht, The Netherlands
Correspondence: J. H. M. Tordoir, Department of Surgery, University Hospital Maastricht, P Debijelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands; Tel: +31-43-3875491; Fax: +31-43-3875743; E-mail: j.tordoir{at}surgery.azm.nl
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Abstract |
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Background. This review describes the peritoneal dialysis (PD) catheter implantation techniques for the treatment of PD. The PD catheter-related complications still cause significant morbidity and mortality, resulting in the necessity to switch to haemodialysis (HD) treatment.
Methods. Several catheter insertion techniques, using an open surgical approach, laparoscopic and percutaneous techniques have been employed, with their specific early and late complications and failure rates.
Results. Despite the similar outcomes of open surgical versus laparoscopic techniques from randomized studies, the laparoscopic insertion has the major advantage of correct catheter positioning in the lower abdomen, with the possibility of adhesiolysis. The minimal invasive percutaneous insertion bears the risk of bowel perforation and catheter malpositioning, and the outcome of this technique is strongly related to the experience of the surgeon. The major complications of these implantation techniques, like bleeding, dialysate leakage and catheter malpositioning, and their management are discussed in our study. Late peritonitis remains the major drawback of PD treatment, with the need of temporary or permanent changeover to the HD treatment in 10% of the patients.
Conclusions. Enrichment of the physician's interest and experience, along with a multidisciplinary approach to outline the optimal strategy of PD-catheter insertion and complication of the treatment, may improve the patients’ survival and decrease the morbidity.
Key Words: peritoneal dialysis • catheter • complications • peritonitis • insertion techniques
Received for publication February 19, 2008. Accepted for publication June 19, 2008.