A Simplified Technique of Rectus Sheath Tunneling in Open Peritoneal Dialysis Catheter Insertion
Prinya Akranurakkul1, Dolrudee Songtish1, Jirayut Janma2, Siribha Changsirikulchai2
Affiliation : 1 Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand, 2 Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Background: Peritoneal dialysis (PD) is the preferred treatment for patients with chronic kidney disease (CKD), however, complications associated with PD catheter placement often result in a patient transferring to hemodialysis (HD). Rectus sheath tunneling is a relatively new technique for laparoscopic PD catheter insertion, aimed at reducing these complications. We examined the outcomes of open PD catheter insertion with rectus sheath tunneling (R-PD) to assess whether the technique decreases these kinds of complications and improves the quality of treatment for CKD patients.
Materials and Methods: A retrospective review was undertaken of 40 CKD patients who had undergone R-PD catheter insertion. The details of R-PD catheter insertion technique, along with a summary of the outcomes, including catheter-related complications and survival time, were reported.
Results: Forty CKD patients were 19 women and 21 men, ranging from ages 24 to 88. Mean operative time for R-PD insertion was 28 minutes (SD, 11.9). Three patients experienced minor abdominal wall bleeding and no patients had iatrogenic visceral organ injury. Catheter dysfunction was found in 3 patients (7.5%). Median catheter survival time was 23 months. Number of functioning catheters at 12 and 24 months were 16 and 14. Cumulative catheter survival rate at 12 and 24 months were 50% and 44%, respectively.
Conclusion: Comparable outcomes were found between R-PD insertion technique and others. Although further research is necessary to ensure that these findings apply over a large group of patients, our results suggest that R-PD insertion is as straightforward, effective, and reproducible as other techniques while offering lower rates of catheter-related complications.
doi.org/10.35755/jmedassocthai.2021.S03.00013
Keywords : Peritoneal dialysis; Open catheterization; Rectus sheath tunneling; Retrospective studies; End stage renal disease
