Open surgical insertion of tenckhoff catheters for peritoneal dialysis.

Abstract

502 There are two important prerequisites for a successful peritoneal dialysis (PD) program: availability of peritoneal access and experience gathered from a reasonable center size (1,2). These two factors are, in turn, closely related because PD uptake rate depends on a comprehensive infrastructure and support system to provide PD catheter access (3,4). Peritoneal access provides the key to PD technique success. Although more than 40 years have passed since Henry Tenckhoff described the permanent silicone catheter with a Dacron cuff, the primary design of the Tenckhoff catheter has remained the most widely used type (5). The ways to insert peritoneal Tenckhoff catheters vary between centers (6). They can be inserted surgically using an open dissection technique, or with the use of a laparoscope or a peritoneoscope. Alternatively, catheters may be inserted percutaneously after blind (or with modified Seldinger technique) puncture of the abdomen; a variation on this blind technique is the fluoroscopyassisted method. There are geographical differences in terms of preferred approach. Peritoneoscopic or laparoscopic insertion is preferred to blind insertion in the United States, whereas open surgical insertion is often practiced in Asia, including in Hong Kong (1,7). In this issue of Peritoneal Dialysis International, Liu et al. (8) report their results for Tenckhoff catheter insertion by an open dissection method under local anesthesia in a Malaysian dialysis unit. A total of 384 catheters were reviewed. How do their results compare with data from other groups? A recent review of mechanical complications with peritoneal catheters evaluated published case series of at least 50 catheters with a follow-up of 3 months or longer (9). Of the 6 studies involving open surgical insertion of PD catheters, the incidence of flow dysfunction was over 10%, with a weighted mean of 13.7% (9). This comes close to the 13.3% rate of catheter migration and/or obstruction observed within 4 weeks of Tenckhoff catheter insertion in the report by OPEN SURGICAL INSERTION OF TENCKHOFF CATHETERS FOR PERITONEAL DIALYSIS