PURPOSE: To report a simple, minimally invasive method of palliative drainage of symptomatic malignant ascites, which allows patients to avoid repeated trips to the hospital for paracentesis. MATERIALS AND METHODS: Since 1996, 29 patients with symptomatic, large-volume malignant ascites underwent percutaneous placement of a tunneled multiple-side-hole Tenckhoff catheter with use of a modified Seldinger technique employing curved and straight coaxial needles. Unlike previously described methods of tunneled catheter placement, this method does not require an incision. RESULTS: All patients were able to drain their ascites at home and all achieved significant improvement in their symptoms attributable to ascites. Twenty-three of the 29 were outpatients and were able to leave the hospital within several hours of catheter placement. Inpatients remained in the hospital for various reasons unrelated to catheter placement and most left within several days. Only one patient died in the hospital during the same admission. One patient developed cellulitis, one had persistent leakage around the catheter, one catheter had to be replaced, and one catheter was accidentally removed at home. No patient developed clinical symptoms of peritonitis or sepsis. All deaths were attributable to patients' underlying malignancies. CONCLUSION: Percutaneous placement of a permanent tunneled catheter using a modified Seldinger technique employing curved and straight coaxial needles is a safe, simple, and effective method for palliative drainage of malignant ascites that allows patients to return home quickly.
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