INSERTION OF A STRAIGHT PERITONEAL CATHETER IN AN ARCUATE SUBCUTANEOUS TUNNEL BY A TUNNELLER - LONG-TERM EXPERIENCE

Objective: This study describes the results of the insertion of a stra ight Tenckhoff peritoneal catheter (PC) in an arcuate, caudally concav e tunnel using a tunneler designed by the authors. It has a semicircul ar shape and a bending radius of 4.5 cm. Setting: A hospital renal uni t. Patients: From June 1988 to February 1994, 112 straight Tenckhoff P Cs, 62 with one deep cuff (single-cuff PC) and 50 with two cuffs (doub le-cuff PC), were inserted as first catheters in 112 patients (mean ag e 62+/-13 years), who underwent continuous ambulatory peritoneal dialy sis (CAPD). The follow-up was 1099 months (mean 18+/-13 months) for si ngle-cuff PCs and 1264 months (mean 25+/-15 months) for double-cuff PC s, respectively. Interventions: After intraperitoneal placement of the PCs by median laparotomy, a 180 degrees are bend tunnel, with both ex ternal and peritoneal exits directed downwards, was created by means o f the tunneler. Results: The rate of exit-site infection (ESI) was 0.2 7 episodes/year (epis/year). The probability of remaining ESI-free was 76%, 60%, and 55% at 1, 2, and 3 years. The rate of tunnel infection (TI) was 0.046 epis/year. The incidence of the double-cuff PC-related ESI and TI tended to be lower than the incidence observed with the sin gle-cuff PC. Episodes of peritonitis were 60 (0.30 epis/year), where 6 were subsequent to ESI and/or TI. Two PCs were lost due to ESI, 3 due to TI, and 11 due to peritonitis. Drainage failure, due to displaceme nt of the PC caused by straightening, involved 3 PCs; 2 were lost. PC survival was 92%, 82%, and 74% at 1,2 and 3 years, respectively. Concl usions: By an easily used semicircular tunneler, the standard straight Tenckhoff PC can be stably positioned in an arcuate tunnel with both inner and outer exits directed downwards. This tunnel shape, as alread y suggested by some authors, appears to be an effective technical solu tion to reducing the PC-related complication rates.