LETTER TO THE EDITOR
Year : 2012 | Volume
: 23 | Issue : 2 | Page : 353--354
Successful percutaneous continuous ambulatory peritoneal dialysis catheter insertion in a patient with past abdominal surgeries
Santosh Varughese, Vinoi George David, Gopal Basu, Anjali Mohapatra, Madhivanan Sundaram, Tamilarasi Veerasamy
Department of Nephrology, Christian Medical College, Vellore, India
Department of Nephrology, Christian Medical College, Vellore
|How to cite this article:|
Varughese S, David VG, Basu G, Mohapatra A, Sundaram M, Veerasamy T. Successful percutaneous continuous ambulatory peritoneal dialysis catheter insertion in a patient with past abdominal surgeries.Saudi J Kidney Dis Transpl 2012;23:353-354
|How to cite this URL:|
Varughese S, David VG, Basu G, Mohapatra A, Sundaram M, Veerasamy T. Successful percutaneous continuous ambulatory peritoneal dialysis catheter insertion in a patient with past abdominal surgeries. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 Jul 13 ];23:353-354
Available from: http://www.sjkdt.org/text.asp?2012/23/2/353/93176
To the Editor,
With the increasing incidence of chronic kidney disease (CKD), percutaneous continuous ambulatory peritoneal dialysis (CAPD) catheter insertion has been suggested as the preferred method in developing countries.  This technique has been avoided in those who have had any previous abdominal surgery  and the lapa-roscopic method is recommended as it has the additional advantage of adhesiolysis.  We report a case of a patient with previous abdominal surgeries in whom percutaneous CAPD catheter insertion was successfully performed.
A 49-year-old lady with CKD stage 5 presented with three months of uremic symptoms and pedal edema. She was a known hypertensive for the past two years. She had history of two abdominal surgeries in the past: a post-partum tubectomy performed 20 years ago and a laparoscopic cholecystectomy performed a month before her presentation here. Both these surgeries had uneventful postoperative courses. On examination, she was a thinly built lady and her abdomen was soft. The surgical scar of the tubectomy was visible in the midline four centimeters (cm) above the pubic symphysis, while four scars of the laparoscopic cholecys-tectomy, each measuring about one cm, were seen mainly in the right hypochondrium. There were no hernias. Ultrasound of the abdomen revealed no abnormality except small echogenic kidneys. Intravenous vancomycin one gram was given pre-operatively as was intra-muscular pentazocin. The skin two cm below the umbilicus was infiltrated with 2% lignocaine and a midline incision, 1.5 cm long, was made. Blunt dissection of the subcutaneous tissue was done until the linea alba was reached. After filling the peritoneal cavity with two liters of saline, using the Seldinger technique, a swan-neck double-cuffed Tenckhoff catheter was introduced and directed toward the right iliac fossa. After securing the catheter in place by purse-string proline sutures, two liters of heparinized CAPD fluid was instilled and drained. The distal end of the catheter was exteriorized via a subcutaneous tunnel. The CAPD fluid flushing and small volume exchanges were successfully begun the day after the surgery with no significant break-in period.  The exchange volumes were gradually increased to regular two liters. There was no obstruction to flow of fluid with larger volumes or inability to tolerate large volumes.
When a tubectomy is performed in the immediate post-partum period, the risk of injury to the peritoneum and adhesions is minimal. Elective laparoscopic cholecystectomy with no postoperative complications also does not have the risk of extensive peritoneal adhesions.
This case illustrates that where there is minimal risk of peritoneal adhesions, percutaneous CAPD catheter insertion can still be attempted. If successful, percutaneous CAPD catheter placement decreases the duration of hospitali-zation  as well as the cost of the procedure.  If there is obstruction to the fluid inflow or drain, or if there is intolerance to larger volumes of fluid, a laparotomy with adhesiolysis and placement of catheter under vision will be required. Percutaneous CAPD catheter insertion is therefore not absolutely contraindicated in patients who have had previous abdominal surgeries if the likelihood of peritoneal adhesions is low and can be attempted as the preferred procedure.
|1||Varughese S, Sundaram M, Basu G, Tamilarasi V, John GT. Percutaneous continuous ambulatory peritoneal dialysis (CAPD) catheter insertion: a preferred option for developing countries. Trop Doct 2010;40:104-5.|
|2||Peppelenbosch A, van Kuijk WH, Bouvy ND, van der Sande FM, Tordoir JH. Peritoneal dialysis catheter placement technique and complications. NDT Plus 2008;1(Suppl4): iv23-8.|
|3||Jo YI, Shin SK, Lee JH, Song JO, Park JH. Immediate initiation of CAPD following percutaneous catheter placement without break-in procedure. Perit Dial Int 2007;27(2):179-83.|
|4||Sampathkumar K, Mahaldar AR, Sooraj YS, Ramkrishnan M, Ajeshkumar, Ravichandran R. Percutaneous CAPD catheter insertion by a nephrologist versus surgical placement: A comparative study. Indian J Nephrol 2008;18: 5-8.|