[Routine omentectomy during Tenckhoff catheter insertion for peritoneal dialysis]

Peritoneal dialysis is now one of the main methods of treating acute and chronic renal failure, and the number of patients treated by continuous ambulatory peritoneal dialysis (CAPD), instead of hemodialysis, is increasing. The most commonly used device for CAPD is the Tenkhoff catheter. The major complications after its insertion are infection and catheter obstruction. To reduce the incidence of obstruction and related complications, usually the result of omental occlusion of catheter ports, we performed routine omentectomy on insertion of the catheter. During 1984-1987 we inserted 56 Tenckhoff catheters for CAPD in 32 males and 20 females ranging in age from 2.5 to 83 years (mean 50.1 +/- 19.7). 32 suffered from end-stage renal disease and 20 from acute temporary renal failure. In 87% local anesthesia was used, and in the others general anesthesia. Omentectomy was performed in 81%. In only 8 patients (15%) omentectomy could not be performed, as the omentum was either too short or was adherent to the abdominal wall as a result of previous abdominal surgery. In an additional 2 patients the omentum was not resected, in 1 because of previous surgery for a perforated duodenal ulcer and in the other because the procedure was performed at the bedside. Peritonitis followed in 14 cases, but in 12 of them it completely resolved after administration of antibiotics. Over a follow-up period of 32 months there was only 1 case of catheter obstruction, significantly fewer than reported in other series. We conclude that routine omentectomy during insertion of the Tenckhoff catheter for CAPD under local anesthesia is safe and reduces the incidence of catheter obstruction during short and long term use.