Surgical Aspects of Peritoneal Dialysis by Stephen Haggerty

Surgical Aspects of Peritoneal Dialysis by Stephen Haggerty

Author:Stephen Haggerty
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham


Techniques of PD Catheter Placement

Peritoneal dialysis catheter placement can be performed in the operating room by surgeons or by minimally-invasive techniques in radiology suites and outpatient procedure centers. Surgical placement has evolved from simple open laparotomy to basic laparoscopic and advanced laparoscopic techniques that include tunneling of catheter segments within the rectus muscle sheath, adhesiolysis and omentopexy [14, 15]. Percutaneous techniques have included blind placement with rigid trochar or a modified Seldinger technique, and the use of a peritoneoscope [14, 16]. The Seldinger technique has evolved to include initial ultrasound guidance of the introducer needle and subsequent fluoroscopic guidance for guide wire placement and catheter positioning [10, 12]. Successful catheter placement has been described with all of the above techniques and ultimate outcomes may be largely due to the experience and skill of the operator.

Placement by laparotomy and basic laparoscopic techniques has resulted in 82–87% 2-year patency rate [14, 17]. Recently, surgical advances in laparoscopic techniques improved the PD catheter placement technique to involve rectus sheath tunneling of the catheter prior to entering of the abdominal cavity combined with adhesiolysis and/or omentopexy, if required. These advanced laparoscopic techniques have been reported to provide 96–99% 5-year patency rate [14, 15].

Despite the improved results with newer surgical approaches, many institutions have increased placement of PD catheter using Interventional Radiology (IR) techniques. Use of ultrasound (US) and fluoroscopic guidance has made this procedure safe and cost effective and a reasonable alternative to traditional surgical catheter placement. Technical success and patency rates from IR placed catheters appear to be equivalent to basic laparoscopic results [12].



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