Xiuling Chen, Nan Wang, Yurong Zou, Jin Chen, Hui Gao, Guisen Li, Junru Wang
{"title":"A Novel Approach to Repositioning Peritoneal Dialysis Catheters.","authors":"Xiuling Chen, Nan Wang, Yurong Zou, Jin Chen, Hui Gao, Guisen Li, Junru Wang","doi":"10.1159/000543824","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Peritoneal dialysis (PD) is a crucial kidney replacement therapy for patients with end-stage kidney disease. Despite its advantages over hemodialysis (HD), long-term success can be hindered by catheter dysfunction, which often necessitates revision. Currently, surgical treatment methods for PD catheter malfunction include fluoroscopy-guided procedures and laparoscopic or open surgery to salvage or replace the catheter. Here, we introduce the first novel, minimally invasive surgery for repositioning PD catheters.</p><p><strong>Methods: </strong>From November 2021 to May 2024, 8 patients with PD catheter dysfunction underwent this innovative procedure at the Department of Nephrology, Sichuan Provincial People's Hospital. Surgical Procedure: On the side of the original abdominal incision, blunt separation was used to find the PD catheter tunnel segment. The anterior rectus abdominal muscle sheath was incised, followed by separation of the deep polyester sleeve. The original catheter was exposed in the abdominal port or purse-string suture, and the intra-abdominal segment of the dialysis catheter was pulled out. Blunt cleaning around the periphery was performed to ensure that the PD catheter was smooth, and a rigid guidewire was placed through the intra-abdominal segment of the proximal end of the catheter of the first lateral hole. The intra-abdominal segment of the PD catheter was placed into the pelvis via the original catheter in the abdominal port. Clinical data were retrospectively collected, and patients were followed up for safety and efficacy assessment.</p><p><strong>Results: </strong>In a study involving 8 patients, no significant complications were observed, with an immediate imaging success rate of 100% and a clinical PD catheter reset success rate of 75%. The catheter remained patent until the end of the study, with a mean follow-up time of 17.25 ± 9.25 months.</p><p><strong>Conclusion: </strong>This new method for resetting dysfunctional PD catheters demonstrates technical feasibility, simplicity, cost-effectiveness, and safety. It has the potential to emerge as an alternative, particularly suitable for resource-limited settings.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"11 1","pages":"104-111"},"PeriodicalIF":3.2000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925479/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000543824","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Peritoneal dialysis (PD) is a crucial kidney replacement therapy for patients with end-stage kidney disease. Despite its advantages over hemodialysis (HD), long-term success can be hindered by catheter dysfunction, which often necessitates revision. Currently, surgical treatment methods for PD catheter malfunction include fluoroscopy-guided procedures and laparoscopic or open surgery to salvage or replace the catheter. Here, we introduce the first novel, minimally invasive surgery for repositioning PD catheters.
Methods: From November 2021 to May 2024, 8 patients with PD catheter dysfunction underwent this innovative procedure at the Department of Nephrology, Sichuan Provincial People's Hospital. Surgical Procedure: On the side of the original abdominal incision, blunt separation was used to find the PD catheter tunnel segment. The anterior rectus abdominal muscle sheath was incised, followed by separation of the deep polyester sleeve. The original catheter was exposed in the abdominal port or purse-string suture, and the intra-abdominal segment of the dialysis catheter was pulled out. Blunt cleaning around the periphery was performed to ensure that the PD catheter was smooth, and a rigid guidewire was placed through the intra-abdominal segment of the proximal end of the catheter of the first lateral hole. The intra-abdominal segment of the PD catheter was placed into the pelvis via the original catheter in the abdominal port. Clinical data were retrospectively collected, and patients were followed up for safety and efficacy assessment.
Results: In a study involving 8 patients, no significant complications were observed, with an immediate imaging success rate of 100% and a clinical PD catheter reset success rate of 75%. The catheter remained patent until the end of the study, with a mean follow-up time of 17.25 ± 9.25 months.
Conclusion: This new method for resetting dysfunctional PD catheters demonstrates technical feasibility, simplicity, cost-effectiveness, and safety. It has the potential to emerge as an alternative, particularly suitable for resource-limited settings.
期刊介绍:
''Kidney Diseases'' aims to provide a platform for Asian and Western research to further and support communication and exchange of knowledge. Review articles cover the most recent clinical and basic science relevant to the entire field of nephrological disorders, including glomerular diseases, acute and chronic kidney injury, tubulo-interstitial disease, hypertension and metabolism-related disorders, end-stage renal disease, and genetic kidney disease. Special articles are prepared by two authors, one from East and one from West, which compare genetics, epidemiology, diagnosis methods, and treatment options of a disease.