Open surgical insertion of tenckhoff catheters for peritoneal dialysis.

摘要

There are two important prerequisites for a successful peritoneal dialysis (PD) program: availability of peritoneal access and experience gathered from a reasonable center size (1,2). These two factors are, in turn, closely related because PD uptake rate depends on a comprehensive infrastructure and support system to provide PD catheter access (3,4).Peritoneal access provides the key to PD technique success. Although more than 40 years have passed since Henry Tenckhoff described the permanentsilicone catheter with a Dacron cuff, the primary design of the Tenckhoff catheter has remained the most widely used type (5). The ways to insert peritoneal Tenckhoff catheters vary between centers (6). They can be inserted surgically using an open dissection technique, or with the use of a laparoscopeora peritoneoscope. Alternatively, catheters may be inserted percutaneously after blind (or with modified Seldingertechnique) puncture of the abdomen; a variation on this blind technique is the fluoroscopy-assisted method. There are geographical differences in terms of preferred approach. Peritoneoscopicorlaparo-scopic insertion is preferred to blind insertion in the United States, whereas open surgical insertion is often practiced in Asia, including in Hong Kong (1,7).