title: Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum.
abstract: BACKGROUND
  The percutaneous Seldinger method of peritoneal dialysis catheter (PDC) insertion has gained favor over recent years whereas traditionally it was reserved for patients considered not fit for general anesthesia. This blind technique is believed to be less safe, and is hence avoided in patients with previous laparotomy incisions. Reports on the success of this method may therefore be criticized for selection bias. In those with no prior abdominal surgery the optimal method of insertion has not been established.
  
  
  METHODS
  We retrospectively reviewed the outcomes of first-time PDC placements comparing the percutaneous (group P) and surgical (group S) insertion techniques in patients without a history of previous abdominal surgery in a single center between January 2003 and June 2010. We assessed catheter survival at 3 and 12 months post-insertion and compared complication rates between the two groups.
  
  
  RESULTS
  A total of 63 percutaneous and 64 surgical catheter insertions were analyzed. No significant difference was noted in catheter survival rates between group P and group S (86.2% vs 80% at 3 months, p = 0.37; and 78.3% vs 71.2% at 12 months, p = 0.42 respectively). Early and overall peritonitis rates were similar (5% vs 5.3%; p = 1, and 3.5 vs 4.9 episodes per 100 patient-months; p = 0.13 for group P and group S respectively). There were also no significant differences between the two groups in exit site leaks (15.9% in group P vs 6.3% in group S; p = 0.15), poor initial drainage (9.5% in group P vs 10.9% in group S, p = 0.34) or secondary drainage failure (7.9% in group P vs 18.8% in group S, p = 0.09).
  
  
  CONCLUSIONS
  This study illustrates the success and safety of percutaneous PDC insertion compared with the open surgical technique in PD naive patients without a history of prior abdominal surgery. Catheter survival was favorable with percutaneous insertion in this low-risk patient population but larger prospective studies may help to determine whether either method is superior. The percutaneous technique can be recommended as a minimally invasive, cost-effective procedure that facilitates implementing an integrated care model in nephrology practice.
authors.affiliation: Nephrology, Adelaide & Meath Hospital, Dublin, Ireland smedani@doctors.org.uk.
authors.forename: Samar
authors.initials: S
authors.lastname: Medani
authors.affiliation: Nephrology, Adelaide & Meath Hospital, Dublin, Ireland.
authors.forename: Wael
authors.initials: W
authors.lastname: Hussein
authors.affiliation: Nephrology, Adelaide & Meath Hospital, Dublin, Ireland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shantier
authors.affiliation: Urology, Adelaide & Meath Hospital, Dublin, Ireland.
authors.forename: Robert
authors.initials: R
authors.lastname: Flynn
authors.affiliation: Nephrology, Adelaide & Meath Hospital, Dublin, Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wall
authors.affiliation: Nephrology, Adelaide & Meath Hospital, Dublin, Ireland.
authors.forename: George
authors.initials: G
authors.lastname: Mellotte
mesh_terms: D000368:Aged; D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010537:Peritoneum / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate
keywords: PD catheter; abdominal surgery; catheter survival; percutaneous insertion; surgical insertion
references.citation: Nephrol Dial Transplant. 2005 Dec;20 Suppl 9:ix8-ix12
references.pmid: 16263753
references.citation: Nephron. 1984;37(2):128-32
references.pmid: 6728087
references.citation: Perit Dial Int. 1990;10(3):231-5
references.pmid: 2094463
references.citation: Adv Perit Dial. 2001;17:122-6
references.pmid: 11510258
references.citation: Perit Dial Int. 1995;15(1):18-21
references.pmid: 7734555
references.citation: Perit Dial Int. 2010 Mar-Apr;30(2):142-50
references.pmid: 20081048
references.citation: Nephron. 1997;75(1):98-9
references.pmid: 9031278
references.citation: Perit Dial Int. 2008 Mar-Apr;28(2):134-7
references.pmid: 18332447
references.citation: Minerva Urol Nefrol. 2004 Dec;56(4):359-65
references.pmid: 15785429
references.citation: Perit Dial Int. 2010 Jul-Aug;30(4):424-9
references.pmid: 20628103
references.citation: Nephron. 1985;40(4):485-7
references.pmid: 4022220
references.citation: Clin J Am Soc Nephrol. 2010 Aug;5(8):1439-46
references.pmid: 20498240
references.citation: Am J Kidney Dis. 2011 Sep;58(3):493; author reply 494
references.pmid: 21856497
references.citation: Semin Dial. 2003 May-Jun;16(3):266-71
references.pmid: 12753690
references.citation: Nephrol Dial Transplant. 1993;8(7):626-30
references.pmid: 8396747
references.citation: J Surg Res. 2014 Mar;187(1):182-8
references.pmid: 24555879
references.citation: Perit Dial Int. 2012 Nov-Dec;32(6):628-35
references.pmid: 22550118
references.citation: Perit Dial Int. 1994;14(3):284-6
references.pmid: 7948245
references.citation: Adv Perit Dial. 1999;15:101-4
references.pmid: 10682081
references.citation: Singapore Med J. 2006 Aug;47(8):707-11
references.pmid: 16865213
references.citation: Kidney Int. 2008 Oct;74(7):946-51
references.pmid: 18650794
references.citation: Perit Dial Int. 2010 Jan-Feb;30(1):41-5
references.pmid: 20056978
references.citation: Nephrol Dial Transplant. 2011 Jul;26(7):2332-9
references.pmid: 21115669
references.citation: Perit Dial Int. 2009 May-Jun;29(3):355-7
references.pmid: 19458310
references.citation: Semin Dial. 2009 Sep-Oct;22(5):569-75
references.pmid: 19747179
references.citation: Semin Dial. 2005 Mar-Apr;18(2):157-60
references.pmid: 15771662
references.citation: Nephron. 1988;48(1):87-8
references.pmid: 3340266
references.citation: Nephron. 1988;48(1):8-11
references.pmid: 3340260
references.citation: Am J Kidney Dis. 2011 Jun;57(6):903-7
references.pmid: 21458901
references.citation: Int J Artif Organs. 2003 Feb;26(2):174-5
references.pmid: 12653353
references.citation: Perit Dial Int. 2008 Mar-Apr;28(2):111-2
references.pmid: 18496930
references.citation: Perit Dial Int. 1998 Jul-Aug;18(4):429-32
references.pmid: 10505567
references.citation: Kidney Int Suppl. 2006 Nov;(103):S27-37
references.pmid: 17080108
references.citation: Perit Dial Int. 2005 Nov-Dec;25(6):556-9
references.pmid: 16411521
references.citation: Am Surg. 2009 Feb;75(2):140-7
references.pmid: 19280807
references.citation: Perit Dial Int. 2004 Jan-Feb;24(1):79-81
references.pmid: 15104344
references.citation: Perit Dial Int. 2007 Mar-Apr;27(2):179-83
references.pmid: 17299155
references.citation: Nephrol Dial Transplant. 2009 Nov;24(11):3499-504
references.pmid: 19556299
references.citation: EDTNA ERCA J. 2003 Jul-Sep;29(3):137-9
references.pmid: 14552087
references.citation: Perit Dial Int. 2007 Sep-Oct;27(5):557-9
references.pmid: 17704447
references.citation: Perit Dial Int. 2002 Mar-Apr;22(2):267-9
references.pmid: 11990415
references.citation: ASAIO Trans. 1991 Jan-Mar;37(1):13-5
references.pmid: 2012711
references.citation: Nephrol Dial Transplant. 2009 Nov;24(11):3274-6
references.pmid: 19745107
references.citation: PLoS One. 2013;8(2):e56351
references.pmid: 23457554
references.citation: ANNA J. 1985 Oct;12(5):307-10
references.pmid: 3851651
references.citation: Nephrol Dial Transplant. 2001 Sep;16(9):1893-9
references.pmid: 11522875
references.citation: Perit Dial Int. 1998 Jan-Feb;18(1):11-33
references.pmid: 9527026
references.citation: Semin Dial. 2008 Nov-Dec;21(6):561-6
references.pmid: 18764787