Surgical management of refractory exit-site/tunnel infection of tenckhoff catheter: Technical innovations of partial replantation

Objective: Catheter-related infection has been the major cause of catheter removal for peritoneal dialysis (PD) patients. A salvage technique-partial replantation of the infected catheter-was developed in our hospital to resc ue catheters with refractory exit-site or tunnel infection. Patients: We performed 26 partial replantations of Tenckhoff catheters for 23 patients with refractory exit-site or tunnel infection and 2 patients wi th near-cuff perforation of the catheter. Their problems were all resolved successfully without interruption of PD. Interventions:We removed the infected portion of the catheter and preserved the still-functioning internal conduit, connecting it to a divided new cat heter. All of the patients resumed PD immediately after the advancement of the new catheter through a new subcutaneous tunnel and exit site on the opp osite side. Results: No technical complications such as disconnection of the catheter o r leakage of dialysate were noted. Repeated partial replantation of the cat heter was done for 1 patient with a new refractory exit-site infection. Tun nel infection was not an absolute contraindication for this procedure. Abou t one third (34.6%) of our patients had preoperative tunnel infection. Conclusion: Partial replantation of a Tenckhoff catheter is a simple and ef fective procedure for patients with refractory exit-site/tunnel infection a nd patients with near-cuff perforation of the catheter. Repeated partial re plantation is also feasible for repeat exit-site infections.