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Laparoscopic-Assisted Seldinger Technique for Peritoneal Dialysis Catheter Insertion
Published on: May 23, 2025
Modified technique of continuous ambulatory peritoneal dialysis catheter insertion in the pediatric population
R Ravichandran1, H N Vikram1, T R Murali1
1Department of Urology, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai 625107, Tamil Nadu, India.
Insights
Placing the superficial cuff deeper to the external oblique aponeurosis during pediatric peritoneal dialysis catheter insertion significantly reduces cuff extrusion and exit site infections. This modified technique offers a promising solution to a common complication.
Area of Science:
- Pediatric Surgery
- Nephrology
- Medical Device Engineering
Background:
- Superficial cuff extrusion and exit site infections are common complications of pediatric peritoneal dialysis catheter insertion.
- Conventional techniques place the cuff in the subcutaneous plane, leading to these adverse events.
Purpose of the Study:
- To evaluate if positioning the superficial cuff deeper to the external oblique aponeurosis reduces complications in pediatric peritoneal dialysis catheter insertion.
- To compare the outcomes of a modified technique versus the conventional method.
Main Methods:
- A retrospective study involving fourteen children undergoing open continuous ambulatory peritoneal dialysis catheter insertion.
- Comparison between eight patients with conventional technique and six patients with a modified technique placing the cuff deeper to the external oblique aponeurosis.
Main Results:
- Three out of eight patients (37.5%) in the conventional group experienced cuff extrusion.
- None of the six patients (0%) in the modified group developed cuff extrusion or exit site infection.
Conclusions:
- Deepening the superficial cuff placement to the external oblique aponeurosis effectively prevents cuff extrusion and exit site infection in pediatric peritoneal dialysis catheter insertion.
- This innovative technique shows promising early results and warrants further investigation through randomized controlled trials.
Objectives:
To assess whether placement of a superficial cuff deeper to the external oblique aponeurosis reduces cuff extrusion and exit site infection in peritoneal catheter insertion in children.
Material And Methods:
In 2013, a total of fourteen children underwent open continuous ambulatory peritoneal dialysis catheter insertion using Tenckhoff double cuffed catheters. The initial eight patients underwent a conventional technique and developed exit site infection and cuff extrusion. In six other patients, the technique was modified by placing the superficial cuff deeper to the external oblique aponeurosis.
Results:
In the former group, three patients developed cuff extrusion, whilst none developed it in the latter, modified group.
Conclusion:
Continuous ambulatory peritoneal dialysis catheter insertion in children is associated with superficial cuff extrusion as a complication. It can be prevented by placing the cuff deeper to the external oblique aponeurosis instead of placing it in the conventional subcutaneous plane. In early experiences with this innovative technique, results have been promising. Randomized controlled trials can thus be undertaken to strengthen this finding.
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