Intraperitoneal Catheter Placement: The “Hammock” Technique

Background

Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States. The NCI released a clinical announcement supporting the use of intraperitoneal chemotherapy in addition to intravenous chemotherapy. However, multiple trials have shown that IP administration is severely limited by catheter complications.

Purpose

We present a new technique for inserting and securing IP catheters in order to prevent the previously reported complications, in particular obstruction of the catheter, bowel and vaginal cuff perforation.

Methods

From March 2006 through February 2010, 38 patients with stage III or IV ovarian cancer underwent optimal cytoreductive surgery and had an IP catheter placed via the “Hammock” technique.

Results

14 patients underwent modified posterior exenteration (37%); 6 underwent splenectomy (16%); thirteen small bowel resections (34%). All 38 patients underwent pelvic and aortic lymphadenectomy. Two patients had reservoir complications; one “flipped over”, and the other had an infection at the port site. Both patient’s elected to discontinue the IP portion of the chemotherapy regimen. 219 cycles of chemotherapy were completed (96%) out of a possible 228 cycles. The only complications were related to the reservoir. There were no catheter-related complications.

Conclusion

As an increasing number of IP catheters are placed at the time of cytoreductive surgery, we will continue to have catheter complications and IP chemotherapy administration difficulties. In using the “Hammock” Technique, we had no catheter complications, and a 96% chemotherapy completion rate. We recommend using the “Hammock” Technique for inserting and securing IP catheters at the time of cytoreductive surgery. .