Surgical technique for peritoneal dialysis catheter placement in the pediatric patient: a North American survey

In the present study, we surveyed 425 members of the American Pediatric Surgical Association and the Canadian Association of Pediatric Surgeons to identify prevalent operative techniques used in the placement of peritoneal dialysis catheters by pediatric surgeons. Our survey assessed catheter type, skin and fascial incision orientations, deep-cuff positions, exit-site directions, and omentectomy. We received responses from 156 surgeons (36.7%) and excluded 18 of those responses. Among the assessed responses, 83 surgeons (60%) indicated that they had placed at least 1 catheter in the previous 12 months. Of the 83, 13% had placed 1 catheter, 52% had placed 2 - 5, 16% had placed 6 - 9, and 18% had placed 10+. We observed significant variability in all aspects of surgical technique. The most common catheter configuration was single-cuff (59%), curled end (60%), and non swan neck (72%). The most common surgical approach was a transverse skin incision (52%), a fascial incision through the rectus (68%), a deep cuff between the peritoneum and fascia (46%), a superior-pointing exit site (37%), and a superficial cuff distant to the exit site (53%). Routine omentectomy was reported by 59% of respondents. Only 15% reported using a laparoscopic approach on first attempt. Pediatric surgeons employ a variety of surgical techniques when placing peritoneal catheters. Some of the techniques used vary from the published recommendations. Quality can potentially be improved by wider dissemination of published surgical recommendations.