Survival and Function of Tenckhoff Peritoneal Dialysis Catheter after Surgical or Percutaneous Placement: One Centre Experience

Long-term, safe access to the peritoneal cavity is a prerequisite for performing successful chronic peritoneal dialysis (PD) (1). After over two decades of Continuous Ambulatory Peritoneal Dialysis (CAPD), catheter related complications are still relatively high and remain the weak point of many peritoneal dialysis programmes. High incidence of complications, such as malfunction of the catheter, exit site infection, tunnel infection and pericatheter fluid leak are reflected by low catheter survival rates. Although many different peritoneal catheter types and methods of implantation have been used, depending mostly on operator’s experience, reports on the complication rate and survival are often conflicting and none has been convincingly proved to be superior to the others (1-6). Few reports directly compare different methods of catheter insertion (7-9). In our centre, at the beginning of CAPD programme both surgical and percutaneous methods of Tenckhoff catheter insertion were used. From January 1994 to April 1996, 43 Tenckhoff catheters were placed in 42 consecutive patients starting the CAPD or Automated Peritoneal Dialysis (APD) treatment in the Department of Nephrology of Gdańsk Medical University. The percutaneous method was performed by midline insertion using percutaneous Seldinger technique with peel-away sleeve (Pull-ApartTM Introducer Set, 16 French, Quinton Instruments Company, USA) (10, 11). This method was implemented in 18 patients, with no history of previous surgical procedures on the abdomen and anticipated good cooperation during the procedure. In the surgical technique the catheter was inserted through a paramedian incision via the rectus muscle. This method was used on 25 occasions in patients who had had abdominal surgical procedures in the past, would not cooperate during the insertion or when umbilical hernia was planned to be repaired at the same time. Surgical method was also chosen in grossly obese patients, and when large polycystic kidneys were present. All CAPD patients were using double bag, disconnect systems (Twinbag, Baxter, Andy Plus, Fresenius and L3, Bieffe Medital) during the study. Catheter survival was determined by Kaplan-Meier analysis. Chi-square testing was used to determine differences between groups. The cumulative observation time was 523 months in the percutaneous method group and 583 months in the surgical method group. The one-year catheter survival was 0.88 for the percutaneous and 0.75 for the surgical Letter to the Editor The International Journal of Artificial Organs / Vol. 26 / no. 2, 2003 / pp. 174-175