Peritoneoscopic Placement of the Tenckhoff Catheter: Further Clinical Experience

Abstract

In the past two and one-half years, 80 Tenckhoff peritoneal catheters have been placed by peritoneoscopic technique using a Needlescope R with a surrounding catheter guide. Peritoneoscopic inspection of the abdomen (after filling with one liter of air), allows placement of the catheter guide in a space free of omental involvement or adhesions. The catheter guide then allows the same small hole used for peritoneoscopy to be gently enlarged to the Tenckhoff catheter size. Of the 80 catheters placed, only three have encountered early failure, one of which was corrected by repositioning (3% early failure rate). Follow-up of catheters placed in chronic dialysis patients showed a half life of 17 months (by actuarial table). Late problems of cuff erosion, outflow obstruction after peritonitis, and cuff infection occur as with Tenckhoff catheters placed by standard techniques. Our experience indicates that early success of the Tenckhoff catheter is improved by peritoneoscopic placement.