Comparison of Percutaneous versus Open Surgical techniques for placement of Peritoneal Dialysis Catheters

  • Imtiyaz Ahmad Wani Department of Nephrology SKIMS
  • Rayees Yousuf Sheikh Department of Medicine, subdivision Nephrology. SRMS IMS Bareilly.
  • Muzafar Masood Wani Department of Nephrology SKIMS
  • Arif Hamid Department of Urology SKIMS
  • Gh Mohammad Bhat Department of Internal Medicine SKIMS
  • Nucksheeba Aziz Bhat Department of Pediatrics SRMS IMS Bareilly.
Keywords: Continuous ambulatory peritoneal dialysis, interventional nephrologists, percutaneous insertion, peritoneal dialysis catheter, surgical insertion

Abstract

Background: Nephrologists have used percutaneous placements of peritoneal dialysis catheters (PDCs) with or without fluoroscopic guidance. PDCs are also placed using mini-laparotomy and laparoscopic techniques by surgeons. Percutaneous PDC placement by nephrologists is a simple, non-invasive technique with minimum intraoperative morbidity. We compared operative and immediate complications of PDCs using percutaneous versus open surgical mode of insertion.

Methods: Data of all patients entering into CAPD programme in our center between July 2011 to July 2015 was collected. A total of 377 PDCs had been inserted over 48 months in 358 patients. Of 377 catheters inserted, 224 had been inserted by percutaneous method and 153 by surgical technique.

Results: Wound hematoma developed in 3.5% of percutaneously placed catheters vs 2.6% of catheters placed by surgical technique, p-0.061. Haemorrhagic effluent was seen in 4.46% of percutaneously placed catheters vs 3.92% of surgically placed catheters, p-0.068. Bowel injury occurred in 1.33% of percutaneously placed catheters vs 0.65% of surgically placed catheters, p-0159. Dialysate leak occurred in 2.6% of catheters placed percutaneously vs 6.5% of catheters placed by surgical technique, p-0.068. Percutaneous PDC allowed a significantly shorter hospital stay, smaller wound size and less break-in period

Conclusions: Percutaneously placed CAPD catheters by nephrologists ensues significantly less hospital stay, small sized incision, lesser break-in period and less post-surgical morbidity as compared with surgically placed catheters. Percutaneous PDC placement is minimally invasive, safe, less time consuming and dependable peritoneal access technique.

Author Biographies

Imtiyaz Ahmad Wani, Department of Nephrology SKIMS

D.M, Additional Professor 

Rayees Yousuf Sheikh, Department of Medicine, subdivision Nephrology. SRMS IMS Bareilly.

D.M, Assistant Professor

Muzafar Masood Wani, Department of Nephrology SKIMS

D.M., Professor

Arif Hamid, Department of Urology SKIMS
M.Ch, Professor
Gh Mohammad Bhat, Department of Internal Medicine SKIMS
M.D., Senior Resident
Nucksheeba Aziz Bhat, Department of Pediatrics SRMS IMS Bareilly.
M.D., Assistant Professor   

References

1. Beathard GA, Litchfield T. Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists. Kidney int.1996; 66:1622-32
2. Asif A, Byers P, Viera CF, Roth D. Developing a comprehensive diagnostic and interventional nephrology program at an academic center. Am J Kidney Dis.2003; 42:229-33
3. Comert M, Borazan A, Kulah E, A new laparoscopy technique for placement of a permanent peritoneal dialysis catheter; the peritoneal tunnelling method. Surg Endosc. 2005 Feb;19(2):245-48.
4. Degesys GE, miller GA, ford KK. Tenckhoff peritoneal dialysis catheters: the use of fluoroscopy in management. Radiology.1985;154:819-20
5. Zaman F, pervez A, Atray NK. Fluoroscopy assisted placement of peritoneal dialysis catheters by nephrologists. Semin Dial.2005;18:247-51
6. Hendersons, Brown E, Lvy J. Safety and efficacy of percutaneous insertion of peritoneal dialysis catheters under sedation and local anaesthetic. Nephrol Dial Transplant 2009; 24:3499-509.
7. Ozener C, Bihoric A, Akolglu E. Technical survival of CAPD catheters: comparison between percutaneous and conventional surgical placement techniques. Nephrol Dial transplant 2001; 16:1893-9
8. Mellotte GJ, Ho CA, Morgan SH, Bending MR, Eisinger AJ. Peritoneal dialysis catheters: a comparison between percutaneous and conventional surgical placement techniques. Nephrol Dial Transplan1993:8:626-30
9. Jo YI, Shin SK, Lee JH, Song JO, Park JH. Immediate initiation of CAPD following percutaneous catheter placement without break-in procedure. Perit Dial Int. 2007; 27:179–83.
10. Moreiras PM, Cuina L, Goyanes GR, Sobrado JA, Gonlez L. Mechanical complications in chronic peritoneal dialysis. Clin Nephrol 1999; 52:124-30.
11. Smith SA, Morgan SH, Eastwood JB. Routine percutaneous insertion of permanent peritoneal dialysis catheters on the nephrology ward. Perit Dial Int 1994; 14:284-86.
12. Allom M, Soucie JM, Macon EJ. Complications with permanent peritoneal dialysis catheters: Experience with 154 percutaneously placed catheters. Nephron 1988; 48: 8-11.
Published
2019-05-27
How to Cite
1.
Wani IA, Sheikh RY, Wani MM, Hamid A, Bhat GM, Bhat NA. Comparison of Percutaneous versus Open Surgical techniques for placement of Peritoneal Dialysis Catheters. jms [Internet]. 2019May27 [cited 2019Jul.19];22(1):54-7. Available from: http://jmsskims.org/index.php/jms/article/view/424
Section
Original Articles