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      Outcomes of peritoneal dialysis catheter configurations and pelvic fixation

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          Abstract

          Background

          Laparoscopic peritoneal dialysis catheter placement has expanded indications, although a relative paucity of data exists about the best configuration for improving outcomes. The purpose of this study is to investigate the role of different catheter configurations and pelvic fixation on catheter and patient outcomes.

          Methods

          Retrospective chart review of patients undergoing peritoneal dialysis catheter implantation between January 1, 2013, and December 31, 2016. All procedures were conducted laparoscopically at a single center. Statistical analyses were conducted using Stata/SE 14.2.

          Results

          Buried catheter configuration was a statistically significant predictor of peritonitis compared to unburied configuration (P = 0.008). Buried catheter was exteriorized at 100 days (SD 107.8). A longer length of time to exteriorization significantly correlated with peritonitis, need for revision, and need for revision pelvic fixation (P < 0.05). Additionally, initial pelvic fixation was a significant predictor of revision (HR 3.94).

          Conclusions

          Peritoneal dialysis catheter placement via a laparoscopic approach can be successfully performed in a diverse patient mix with positive results. However, buried catheter configuration and prophylactic pelvic fixation should be carefully employed in select patients.

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          Most cited references14

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          Cost comparison of peritoneal dialysis versus hemodialysis in end-stage renal disease.

          John Edelsberg, Ariel Berger, Gary W Inglese … (2009)
          To compare healthcare utilization and costs in patients with end-stage renal disease (ESRD) beginning peritoneal dialysis (PD) or hemodialysis (HD). Retrospective cohort study. Using a US health insurance database, we identified all patients with ESRD who began dialysis between January 1, 2004, and December 31, 2006. Patients were designated as PD patients or as HD patients based on first-noted treatment. Patients with less than 6 months of pretreatment data and those with less than 12 months of data following initiation of dialysis ("pretreatment" and "follow-up," respectively) were dropped from the study sample. The PD patients were matched to HD patients using propensity scoring to control for differences in pretreatment characteristics. Healthcare utilization and costs were then compared over 12 months between propensity-matched PD patients and HD patients using paired t tests and Wilcoxon signed rank tests for continuous variables and using Bowker and McNemar tests for categorical variables, as appropriate. A total of 463 patients met all study entrance criteria; 56 (12%) began treatment with PD, and 407 (88%) began treatment with HD. Fifty PD patients could be propensity matched to an equal number of HD patients. The HD patients were more than twice as likely as matched PD patients to be hospitalized over the subsequent 12 months (hazard ratio, 2.17; 95% confidence interval, 1.34-3.51; P <.01). Their median healthcare costs over the 12-month follow-up period were $43,510 higher ($173,507 vs $129,997 for PD patients, P = .03). Among patients with ESRD, PD patients are less likely than HD patients to be hospitalized in the year following initiation of dialysis. They also have significantly lower total healthcare costs.
          Article 0 comments Cited 30 times – based on 0 reviews     Review now
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            Selected best demonstrated practices in peritoneal dialysis access.

            Mark Crabtree (2006)
            Many burdensome interventions that adversely affect the utilization of peritoneal dialysis as renal replacement therapy and patient satisfaction with this treatment modality can be avoided by early peritoneal access placement with embedded catheters, implantation techniques that preempt common catheter complications, and the use of access devices that provide flexibility in exit site location. Catheter embedding consists of subcutaneously burying the external limb of the catheter tubing at the time of the insertion procedure. Interval exteriorization of the catheter is performed when dialysis is needed. Earlier commitment by patients to peritoneal dialysis can be achieved by elimination of catheter maintenance until dialysis is necessary. Catheter embedding is a practical strategy to avoid temporary hemodialysis with vascular catheters and reduces stress on operating room access by allowing more efficient scheduling as non-urgent procedures. Laparoscopic catheter placement enables proactive techniques not available to other conventional insertion methods. These techniques include rectus sheath tunneling to prevent catheter tip migration, selective prophylactic omentopexy to prevent omental entrapment, selective resection of epiploic appendages to prevent catheter obstruction, adhesiolysis to eliminate compartmentalization, and diagnosis and simultaneous repair of previously undiagnosed abdominal wall hernias. Both standard and extended 2-piece catheter systems are necessary to customize the peritoneal access to a variety of body configurations. Catheters should be able to produce lower abdominal, mid-abdominal, upper abdominal, and upper chest exit site locations that facilitate management by the patient without sacrificing deep pelvic position of the catheter tip or resulting in excessive tubing stress during passage through the abdominal wall.
            Article 0 comments Cited 21 times – based on 0 reviews     Review now
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              Comparison of open and laparoscopic secure placement of peritoneal dialysis catheters.

              T Simapatanapong, P Soontrapornchai (2004)
              A major and frustrating complication of peritoneal dialysis catheter placement is mechanical outflow obstruction, which may be caused by catheter tip migration. Therefore, a secure and correct positioning of the catheter is important to minimize this risk. This technique is easily accomplished by a laparoscopic approach. The outcomes of 50 patients in whom peritoneal dialysis catheters were inserted laparoscopically with a secure catheter placement technique were compared with those of 52 patients who underwent an open surgical technique using a stiff wire as guidance for the catheter. The data were prospectively collected but not randomized. All the patients had virgin abdomens, and all the procedures were undertaken or supervised by one surgeon. Catheter migration occurred in six patients (12%) in the open group, as compared with none in the laparoscopic group (p = 0.027). There were no significant differences in catheter survival between the two groups. The laparoscopic technique with secure placement of the catheter lowered the incidence of catheter migration, but did not increase the catheter survival.
              Article 0 comments Cited 16 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Eric S. Hager
                Journal
                Journal ID (nlm-ta): Surg Open Sci
                Journal ID (iso-abbrev): Surg Open Sci
                Title: Surgery Open Science
                Publisher: Elsevier
                ISSN (Electronic): 2589-8450
                Publication date PMC-release: 18 May 2019
                Publication date Collection: July 2019
                Publication date (Electronic): 18 May 2019
                Volume: 1
                Issue: 1
                Pages: 34-37
                Affiliations
                [a ]School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
                [b ]Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
                Author notes
                [* ]Corresponding author at: Division of Vascular Surgery, UPMC St. Margaret - Medical Arts 200, 200 Delafield Rd. Suite 4050, Pittsburgh, PA 15215. Tel.: + 1 412 802 3333. hageres@ 123456upmc.edu
                Article
                Publisher ID: S2589-8450(19)30004-1
                DOI: 10.1016/j.sopen.2019.05.001
                PMC ID: 7391890
                PubMed ID: 32754690
                SO-VID: 0db0661b-8086-493d-af3d-bf308e31fee8
                Copyright © © 2019 Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 7 December 2018
                Date revision received : 30 April 2019
                Date accepted : 2 May 2019
                Categories
                Subject: Article

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