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Published on: May 23, 2025
Surgical complications of Tenckhoff catheters used in continuous ambulatory peritoneal dialysis
H Y Tiong1, J Poh, K Sunderaraj
1Department of Urology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. ho_yee_tiong@nuh.com.sg
Insights
Open Tenckhoff catheter insertion for continuous ambulatory peritoneal dialysis (CAPD) has significant risks. Early complications include infections and malfunctions, while late complications involve peritonitis, necessitating optimized patient care and surgical planning.
Area of Science:
- Nephrology
- Surgical Procedures
- Medical Device Complications
Background:
- Open Tenckhoff catheter insertion is a common procedure for initiating continuous ambulatory peritoneal dialysis (CAPD).
- Auditing early and late complications is crucial for improving patient outcomes and procedural safety.
Purpose of the Study:
- To audit the early and late complications associated with open Tenckhoff catheter insertion performed under local anesthesia.
- To identify risk factors for these complications and inform strategies for risk mitigation.
Main Methods:
- Retrospective analysis of 164 Tenckhoff catheter insertions in 139 patients over a three-year period.
- Data collection included patient characteristics, operative factors, and early/late complications until study endpoint.
Main Results:
- Early complications occurred in 31% of insertions (wound infections, catheter malfunctions).
- Late complications occurred in 26% (primarily CAPD peritonitis).
- Diabetes, sepsis, previous surgery, and prolonged operative time were associated with early complications; poor nutrition impacted late complications.
Conclusions:
- Tenckhoff catheter insertion carries significant morbidity, with specific patient groups at higher risk for early complications.
- Optimizing patient conditions pre-surgery and considering laparoscopic approaches for high-risk individuals may reduce complications.
- Preventing late peritonitis requires attention to nutritional status and catheter care.
Introduction:
The objective of this study was to audit the early and late complications of open Tenckhoff catheter insertion under local anaesthesia in a single institution.
Methods:
A review was carried out on 164 insertions in 139 patients over a three-year period. All patient records were retrospectively analysed until the time of transfer to haemodialysis, death, or to current time if alive and receiving continuous ambulatory peritoneal dialysis (CAPD). Patient characteristics, operative factors, early and late complications were recorded.
Results:
Early complications were reported in 31 percent of catheter insertions, predominantly wound infections and catheter malfunctions. The factors that were significantly associated with early complications were diabetes mellitus, glomerulonephritis, ongoing sepsis, previous abdominal surgery and prolonged surgical time. Late complications were seen in 26 percent of catheter insertions, mainly CAPD peritonitis. Poor nutritional status had a significant negative impact on late complications. The overall median catheter survival time was 41.9 months (95 percent confidence interval, 25.8-58.0 months). In addition, no significant difference in catheter survival time was detected between those patients with and those without diabetes mellitus.
Conclusion:
Tenckhoff catheter insertion for CAPD is a procedure associated with significant surgical morbidity. Patients with diabetes mellitus, glomerulonephritis and ongoing sepsis are at greater risk of early complications, and hence, must have their conditions stabilised or treated before surgery. In addition, prolonged surgical time and patients with previous abdominal surgery are at increased risk. The rate of complications may be improved by early consideration of patients with poor tolerance of local anaesthetic surgery or with previous abdominal surgery for laparoscopic insertion under general anaesthesia. To prevent late complications dominated by CAPD peritonitis, patients' nutritional status and care of the catheter should both be optimised.
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