A Comparison between Percutaneous and Surgical Placement Techniques of Permanent Peritoneal Dialysis Catheters

Dr. Kenan Ateş, Başçavuş sokak 19/10, Seyranbağlari, TR-06660 Ankara (Turkey) Table 1. Complication rates and catheter longevity following percutaneous or surgical catheter placement techniques Dear Sir, Continuous ambulatory peritoneal dialysis (CAPD) has been established as an effective treatment of end-stage renal disease. The key to successful CAPD is permanent and safe access to the peritoneal cavity. Several implantation techniques for the peritoneal dialysis catheter, such as percutaneous, open surgical and laparoscopic procedures, have been described [1-4]. The type of catheter implantation technique may influence the success of the CAPD procedure [2, 5]. Some studies have suggested that the percutaneous placement technique has caused more catheter-related complications than the surgical procedure [6, 7]. However, the optimal approach to the implantation technique of the catheter is still a matter of debate. In this study, we carried out a retrospective analysis of all peritoneal dialysis catheters inserted by both percutaneous and surgical techniques, and compared complication rates and catheter survival. A total of 284 patients with end-stage renal disease, 171 males and 113 females, were maintained on CAPD between March 1985 and December 1994. The mean age was 45.8 ± 13.6 years (15-76 years). In 219 cases catheters were placed percutaneously using the Tenckhoff Trocar technique, and in 65 cases catheters were placed surgically under general or spinal anaesthesia. Peritoneal dialysis was started between the 4th and 5 th days after placements using a 1-litre dial-ysate volume. The incidence of peritonitis, exit-site/tunnel infection, drainage failure and other mechanical complications, such as cuff extrusion, dialysate leak, hernia, abdominal or genital edema, and the longevity of catheter were compared using Student’s t test, χ2 test or life table analysis as appropriate. Age, sex, etiology of renal failure and catheter design were similar between both groups. The incidence of peritonitis and exit-site/tunnel infections were not significantly different between the 2 groups. Also, early and late drainage failure, and other mechanical complications were