Early Postoperative Complications of Peritoneal Dialysis Catheter Surgery Conducted by Nephrologists: A Single-Center Experience Over an Eight-Year Period.

Abstract

The results of several recent studies indicate that the practice of peritoneal dialysis catheter (PDC) insertion by nephrologists is safe. However, few studies have addressed the important issue of safety in surgeries related to PD, including PDC removal and other types of surgery. In the present study, we aimed to verify whether the incidence of early postoperative complications for surgical procedures related to PD and performed by nephrologists meets the audit standards of clinical practice guidelines for peritoneal access.Between April 2008 and July 2016 at our hospital, 282 patients underwent various types of PD-related surgery conducted by 17 nephrologists. The surgery types were the Moncrief-Popovich technique (n = 74), PDC exteriorization (n = 62), conventional laparotomy insertion (n = 29), PDC removal (n = 70), partial replacement (n = 32), unroofing or cuff shaving (n = 7), and others (n = 8).Bowel perforation and significant hemorrhage did not occur at the time of PDC insertion and removal. Although peritonitis was not evident, exit-site and tunnel infection within 2 weeks of PDC insertion by conventional laparotomy or exteriorization after the Moncrief-Popovich technique occurred in 3 of 91 patients (3.3%). The PDC malfunctioned in 2 of 103 patients (1.9%) after the Moncrief-Popovich technique because of PDC occlusion with a fibrin plug. Dialysate leaks occurred in 2 of 103 patients (1.9%). Partial replacement and unroofing or cuff shaving for refractory PDC infection and other type of surgeries were not associated with serious complications.The incidence of complications after surgery related to PD was low at our institution. The incidences of complications met the audit standards in the guidelines, indicating that surgery by nephrologists is safe and effective.