Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2022; 10(4): 1182-1189
Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1182
Importance of the creation of a short musculofascial tunnel in peritoneal dialysis catheter placement
Chih-Yuan Lee, Meng-Kun Tsai, Yi-Ting Chen, Yu-Jun Zhan, Min-Ling Wang, Chien-Chia Chen
Chih-Yuan Lee, Meng-Kun Tsai, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
Meng-Kun Tsai, Division of General Surgery, Department of Surgery, National Taiwan University Biomedical Park Hospital, National Taiwan University Hospital Hsinchu Branch, Hsinchu 302, Taiwan
Yi-Ting Chen, Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
Yi-Ting Chen, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hosptial, Taipei 100, Taiwan
Yu-Jun Zhan, Min-Ling Wang, Department of Nursing, National Taiwan University Hospital, Taipei 100, Taiwan
Chien-Chia Chen, Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
Author contributions: Chen CC and Lee CY conceived the study and wrote the manuscript; Tsai MK, Chen YT, Zhan YJ, and Wang ML were involved in medical record review and data analysis; all authors reviewed and edited the manuscript and approved the final version of the manuscript.
Institutional review board statement: This retrospective study was approved by the Research Ethics Committee of the National Taiwan University Hospital (202106072RINA).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chien-Chia Chen, MD, PhD, Doctor, Division of General Surgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung Shan South Road, Zhongzheng Dist, Taipei 100, Taiwan. 010419@ntuh.gov.tw
Received: September 16, 2021
Peer-review started: September 16, 2021
First decision: November 7, 2021
Revised: November 20, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: February 6, 2022
Processing time: 130 Days and 2.4 Hours
Abstract
BACKGROUND

Peritoneal dialysis (PD) catheter migration impedes the efficacy of dialysis. Therefore, several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis.

AIM

To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation.

METHODS

Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study. The patients were divided into two groups based on the procedure performed: Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017. We recorded patient characteristics and catheter complications over a two-year follow-up period. In addition, postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration.

RESULTS

The no-tunnel and tunnel groups included 115 and 107 patients, respectively. Compared to the no-tunnel group, the tunnel group showed lesser catheter angle deviation toward the pelvis (15.51 ± 11.30 vs 25.00 ± 23.08, P = 0.0002) immediately after the operation, and a smaller range of migration within 2 years postoperatively (13.48 ± 10.71 vs 44.34 ± 41.29, P < 0.0001). Four events of catheter dysfunction due to migration were observed in the no-tunnel group, and none occurred in the tunnel group. There was no difference in the two-year catheter function survival rate between the two groups (88.90% vs 84.79%, P = 0.3799).

CONCLUSION

The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration, thus preventing catheter dysfunction.

Keywords: Catheter migration; Peritoneal dialysis; Tenckhoff catheter implantation; Renal replacement

Core Tip: We present a simple add-on procedure to the traditional open surgery method of peritoneal dialysis catheter implantation. Our method does not need an additional incision, suture, or change of surgical site. We analyzed images of the catheter and measured its deviation angle, which is related directly to the so-called “migration”. Indeed, patients who underwent the traditional method had a greater initial deviation angle and more angle shift in later images than did those who underwent the modified catheter implantation. This simple modification helps to maintain the catheter in the expected orientation, which will increase the efficacy of dialysis.