The comparison in terms of early complications of a new technique and percutaneous method for the placement of CAPD catheters.
BACKGROUND
Starting continuous ambulatory peritoneal dialysis (CAPD) immediately after insertion of a peritoneal dialysis catheter is essential in end-stage renal disease (ESRD). In relation to the insertion methods, various mechanical and infectious complications may arise. In this study, we aimed to compare early complications of the laparoscopic tunneling method of CAPD placement that we developed recently in order to minimize the complications, with those of the conventional percutaneous method.


METHODS
Included in this study were 12 consecutive patients with ESRD to whom we introduced catheters for CAPD by way of laparoscopic tunneling between April 2003 and July 2003 and followed up for at least 6 months, and 30 patients to whom the catheters were placed percutaneously in the same time period with the same follow-up time. The complications seen during the first 6 months after catheter placement with these two different methods were compared.


RESULTS
In all of the subjects, dialysis was started soon after catheter placement. No peroperative morbidity was seen in any of the patients. While with laparoscopic tunneling method no mechanical problem was seen, the percutaneous method resulted in early leakage in 10%, pericatheter bleeding in 3.3%, and hernia in 3.3% of the patients. As infectious complications, peritonitis occurred as one episode/36 patient-months in laparoscopic tunneling and one episode/22.5 patient-months in percutaneous method; catheter insertion site infection was seen in none in the laparoscopic method, while one episode/90patient-months was seen with the percutaneous method. Tunnel infection did not arise in any of the subjects.


CONCLUSIONS
The authors of this study think that the peritoneal tunneling method for introducing CAPD, which has been recently developed and began to be routinely used by them, is rather safe in terms of early complications.
Borazan
Ali
A
Department of Internal Medicine, Zonguldak Karaelmas University, The School of Medicine, Zonguldak, Turkey. borazanali@hotmail.com
Comert
Mustafa
M
Ucan
Bülent Hamdi
BH
Comert
Fusun Begendik
FB
Sert
Mehmet
M
Sekitmez
Nedred
N
Cesur
Ali
A
D000328:Adult; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation*; D011446:Prospective Studies; D013997:Time Factors