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      Comparing the outcomes of open surgical procedure and percutaneously peritoneal dialysis catheter (PDC) insertion using laparoscopic needle: A two month follow-up study

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          Abstract

          BACKGROUND:

          This study was performed to compare the outcomes of open surgical procedure and percutaneously peritoneal dialysis catheter (PDC) insertion using laparoscopic needle.

          METHODS:

          This randomized clinical trial study was conducted in the Nephrology Department in Noor Hospital, Isfahan, Iran between 2009 and 2010. 64 uremic patients were randomized into two study groups using random allocation software. Thirty four catheters were inserted percutaneously (P group) and 30 catheters were placed surgically (S group). Collected information included demographic data, body mass index, and cause of renal disease, duration of operation and length of hospitalization. Outcomes were considered as mechanical and infectious complications.

          RESULTS:

          There were no significant differences in age, gender, the mean of body mass index, having history of hemodialysis, diabetes mellitus, hypertension, ischemic heart disease, and length of hospitalization. Hemopenitoneom was more frequent in S group than P group (13.3% versus 3.2%; p < 0.0001). There was no significant difference between two groups in early peritonitis, early leakage, hernia, hollow viscous perforation, catheter obstruction, and malpositioning and the time of peritoneal dialysis onset. Outflow failure and the exit site infection were more frequent in S group than P group (p < 0.0001). Mean of the operative time was longer in S group than P group (27.70 ± 2.79 minutes versus 10.48 ± 1.91 minutes, p < 0.001).

          CONCLUSIONS:

          Percutaneous catheter insertion has fewer rate of complications and is less time consuming in comparison with surgical method.

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          Most cited references18

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          Technical survival of CAPD catheters: comparison between percutaneous and conventional surgical placement techniques.

          Percutaneous peritoneal dialysis catheter (PDC) placement is a well-tolerated, rapidly performed bedside procedure that allows a rapid initiation of CAPD. We compared the technical survival of PDCs while comparing the mode of insertion. We retrospectively reviewed 215 PDCs inserted over a 60-month period in 191 patients on CAPD therapy. Of these, 133 were placed percutaneously by nephrology staff (group P) and 82 were placed using conventional surgical techniques by surgical staff (group S). The total experience accumulated was 4000 patient-months: 2260 patient-months in group P and 1740 patient-months in group S. The incidence of complications in PDCs did not differ between the groups (1 episode/33 patient-months in group P and 1 episode/29 patient-months in group S). Two episodes of early leakage and 9 episodes of late leakage were observed in group P compared with one early leakage and 4 episodes of late leakage in group S. Of the mechanical complications in group P, 8.86% were due to catheter malfunction, including catheter tip migration and obstruction, compared with 12.63% in group S. The incidence of catheter infections was 1 episode/73 patient-months in group P and 1 episode/62 patient-months in group S. Significantly more catheters were removed in group S compared with group P (40% vs 16%, P<0.001). One-year and 2-year technical survivals were 90% and 82% in group P, and 73% and 60% in group S (P=0.0032), respectively. Percutaneous bedside placement of PDCs by nephrologists provides a safe and reliable access for peritoneal dialysis.
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            Safety and efficacy of percutaneous insertion of peritoneal dialysis catheters under sedation and local anaesthetic.

            Success of peritoneal dialysis (PD) is partially dependent on the ease of insertion of the catheter. We have been inserting PD catheters percutaneously in a majority of our patients under local anaesthetic and sedation by physicians, and detail here the outcomes for 283 catheters inserted in this manner, and 150 patients with surgical catheter insertion by laparotomy or laparoscopy. Data were collected prospectively on all patients having PD catheters inserted between 1999 and 2008, including success of insertion, complications and infections. A total of 283 catheters were inserted percutaneously using a Seldinger technique under sedation and local anaesthesia, and 150 surgically under general anaesthetic. Eighty-six percent of the percutaneous catheters and 66% surgical catheters were first catheters. No major complications occurred. In 7% of the percutaneous patients and 5% surgical patients, the procedure failed or was abandoned. Poor initial drainage occurred in 21% insertions but resolved in most cases and resolved dialysate leak in 6%. Wound infections or peritonitis occurred in 9% and 4% of percutaneous insertions. Only 13% of patients could not use their catheter at 1 month after percutaneous insertion, and 83% of the patients remained on PD using the original catheter at 6 months. Percutaneous PD catheter insertion was associated with a very low complication rate and high primary success rate, and was highly efficient in use of resources and avoided the need for general anaesthesia.
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              Patients' descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis.

              There has been increasing interest in understanding how patients with chronic renal failure choose between chronic peritoneal dialysis (CPD) and hemodialysis (HD) for renal replacement therapy. The purpose of the present study was to examine the influences and specific factors that patients identify as significant in choosing a specific dialysis modality for treatment of their end-stage renal disease (ESRD). 40 patients (20 CPD, 20 HD) who had started dialysis within the preceding 6 months were randomly selected to participate in the study. A structured interview was conducted with the patients, discussing and exploring what factors patients thought were important in helping them decide their treatment modality. The format of the interview was open-ended. Based on patients' comments, a taxonomy of the specific factors that influenced the patients' decisions was developed. The study was conducted in a freestanding CPD unit and two freestanding HD units. All 20 CPD patients reported choosing their treatment modality; only 8 of the 20 HD patients reported having a choice of treatment modality. 18 of the 22 patients who participated in predialysis educational programs opted for CPD. 83% of the patients reported that their physician was important in influencing their treatment choice; however, the CPD patients relied more on written material and the opinions of their spouse/significant other or other family members in making their decisions. Issues of autonomy and control were important for 95% of patients choosing CPD. Both CPD and HD patients cited a variety of treatment-specific factors. The three most frequently cited reasons for choosing CPD were (1) flexibility of schedule (19 patients), (2) convenience of performing CPD in their own home (19 patients), and (3) the option of doing dialysis at night while sleeping (8 patients). The 8 HD patients who selected their treatment modality cited the desirability of having a planned schedule (7 patients) and letting nurses or other take care of them (5 patients). The present study explored factors perceived by patients as being important in determining their choice of renal replacement therapy. A taxonomy of patient influences and concerns has been developed to provide caregivers with a framework to structure their educational strategies and assist patients with progressive renal failure in making an informed choice of therapeutic modality for their ESRD treatment.
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                Author and article information

                Journal
                J Res Med Sci
                JRMS
                Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
                Medknow Publications Pvt Ltd (India )
                1735-1995
                1735-7136
                April 2011
                : 16
                : 4
                : 463-468
                Affiliations
                [a ] Assistant Professor of Nephrology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
                [b ] Resident of General Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
                [c ] Nurse of CAPD Ward, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
                [d ] Associate Professor of Vascular Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
                Author notes
                [* ] Corresponding Author E-mail: beigi@ 123456med.mui.ac.ir
                Article
                JRMS-16-463
                3214349
                22091260
                4ebded38-7cbc-47dd-a7e8-eae2d797e840
                Copyright: © Journal of Research in Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 December 2010
                : 05 March 2011
                Categories
                Original Article

                Medicine
                laparoscopy,catheter ablation,needles,peritoneal dialysis
                Medicine
                laparoscopy, catheter ablation, needles, peritoneal dialysis

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