title: Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction.
abstract: OBJECTIVE
  Catheter malfunction is the main reason for early peritoneal dialysis (PD) technique failure. This study aimed to evaluate the effect of a new surgery technique with catheter fixation to the lower abdominal wall combined with straight upward tunnel and low implant position in reducing catheter malfunction.
  
  
  METHODS
  Patients with end stage renal disease who received PD in our centre from January 2013 to December 2015 were involved in this study. They were randomly divided into three groups according to surgical technique: traditional open surgery group, modified open surgery group and modified open surgery with catheter fixation group. All patients were followed up for six months after surgery. Catheter- related complications were analyzed.
  
  
  RESULTS
  A total of 152 patients were involved. Among them, 49 received traditional open surgery (TOS group), 49 received modified open surgery (MOS group), and 54 received modified open surgery with catheter fixation (MOS-F group). During follow-up, no patients (0%) in MOS-F group developed catheter malfunction which was significantly lower than that of the TOS group (0 vs 16.33%, P = 0.002). Although not statistically significant, the incidence of catheter malfunction was lower in MOS-F group than that in MOS group (0 vs 4.08%, P = 0.134). No significant difference was observed in the episodes of infection, bleeding, leakage, inflow or outflow pain, hernia and delayed wound healing among the three groups (all P > 0.05).
  
  
  CONCLUSIONS
  Catheter fixation combined with straight upward tunnel and low implant position can effectively prevent catheter malfunction in PD catheter placement.
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Qingyan
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Chunming
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Cheng
authors.initials: C
authors.lastname: Sun
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Tianfeng
authors.initials: T
authors.lastname: Tang
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wan
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Qiuyuan
authors.initials: Q
authors.lastname: Shao
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Bo
authors.initials: B
authors.lastname: Jin
authors.affiliation: Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University.
authors.forename: Miao
authors.initials: M
authors.lastname: Zhang
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D002681:China; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome
keywords: catheter fixation; catheter malfunction; low implant position; peritoneal dialysis; straight upward tunnel