A novel method for salvage of malfunctioning peritoneal dialysis catheter.
BACKGROUND
Continuous ambulatory peritoneal dialysis (CAPD) has been widely used as an effective therapy in the management of patients with end-stage renal disease. Long-term use of CAPD needs methods with low incidence of catheter-related complications. Moreover, some complications may cause failure of fluid drainage and treatment interruption.


OBJECTIVE
We have innovated and studied a new minimal-invasive method of malfunctioning peritoneal catheter repair.


METHODS
Thirty-five patients agreed to undergo catheter rescue operation by this new method during 2004 and 2012. Under local anesthesia and light sedation, access to the abdominal cavity was made, the catheter and wrapped omentum grasped and the tip of catheter was released, debris were removed and the catheter was directed toward the pelvic floor with a finger guide. The patients were followed after catheter salvage up to the end of study (April 2012). PD catheter function restored to the normal level in 28 (80%) of patients, and PD was started 1-2 days after the procedure.


RESULTS
All patients had an uneventful recovery. PD catheter function was restored to the normal level in 28 (80%) patients, and PD was started 1-2 days after the procedure. Of these patients, 10 (35%) died of reasons unrelated to catheter or catheter complications; 7 (25%) were ultimately referred for kidney transplant; 8 (29%) continued PD up to the end of this study with no problem, and only 3 (11%) due to catheter complications. Catheter function did not restore to the normal level in seven patients (20%); however, six patients continued PD for 1-18 months with the catheter.


CONCLUSIONS
Comparing the advantages and disadvantages of this method to the previous laparoscopically repaired catheter, we concluded that this new method is efficient, and is a suitable way for malfunctioning PD catheter salvage.
Department of Pediatric Surgery, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ali Akbar
AA
Beig
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
Sayed Mahdi
SM
Marashi
Department of Pediatric Surgery, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Hojatollah Raji
HR
Asadabadi
Department of Pediatric Surgery, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ali
A
Sharifi
Faculty of Educational Sciences and Psychology, Shahid Beheshti University, Tehran, Iran.
Zohre Nasiri
ZN
Zarch
Catheter malfunction; catheter rescue; continuous ambulatory peritoneal dialysis; minimally invasive surgery; peritoneal dialysis