The pedfix technique: a new minimally invasive method of peritoneal dialysis catheter insertion with secure fixation...

Peritoneal Dialysis (PD) is the most common modality of renal replacement therapy in children with acute kidney injury (AKI). Various open and laparoscopic techniques for the placement of peritoneal dialysis (PD) catheter, with or without intra-abdominal fixation, have been described. The incidence of catheter migration after PD is 0-19%. We present a new, modified technique which minimizes the risk of catheter migration and blockage.

For 18 years a laparoscopic assisted PD catheter insertion has been used by the first author with a single 5 mm Port at the umbilicus using an inverted J incision and a Seldinger technique, with either a 14 or 16 Fr introducer kit. In October 2024, the technique was modified to include fixation of the catheter to the lower anterior abdominal wall using an Endoclose device (Autosuture, Covidien).

Six patients- 4 boys, mean age at surgery 7.8 years- underwent PD catheter insertion using the modified technique. All patients were in End Stage Kidney Disease due to posterior urethral valves and renal dysplasia (2), nephronophthisis (1) renal dysplasia (1), focal segmental glomerulosclerosis (1) multi-cystic dysplastic kidney on one side and dysplasia on the contralateral side (1). All six cases underwent successful placement of a PD catheter. Four patients had no post-operative complications, one patient developed an incisional hernia at the Hasson port, while one patient required laparoscopic repositioning of the PD catheter and fixation to the abdominal cavity with a non-absorbable suture (2 - 0 Ethibond) at a mean follow up of 10.4 months.

The Pedfix technique provides excellent cosmetic results, optimal pelvic visualization and fixation of the PD catheter to the lower anterior abdominal wall which minimizes the risk of catheter migration and blockage. These encouraging results need to be confirmed by a prospective study with longer follow up.