The Peritoneal Tie Technique: Our Laparoscopic Catheter Placement for Peritoneal Dialysis

The Peritoneal Tie Technique: Our Laparoscopic Catheter Placement for Peritoneal Dialysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Peritoneal Tie Technique: Our Laparoscopic Catheter Placement for Peritoneal Dialysis Giuseppina Oliva, Sorrentino Carmen, Santella Gianluigi, Lombardi Guido, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4283193/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Peritoneal dialysis (PD) is a safe and effective replacement therapy for patients with terminal stage renal disease, alternative to hemodialysis. However, its success depends on the placement of a peritoneal catheter with a safe, functional and durable access. Currently, several techniques are put into practice for peritoneal catheter placement. Methods We present a detailed stepwise description of our operative technique for PD catheter placement. This description is combined with intraoperative photographs to highlight key steps. Results we describes potential pitfalls that may prevent optimal catheter function and We report our results in the medium and short term Conclusion This technique performe safely and standardized reproducible method for minimally invasive placement of peritoneal dialysis catheters, peritoneal dialysis laparoscopic catheter placement fixation peritoneal Figures Figure 1 Figure 2 Figure 3 BACKGROUND Peritoneal dialysis (PD), first described as a long-term management modality for end-stage renal disease (ESRD) in 1976, is becoming an increasingly utilized method for renal replacement therapy ( 1 ) Peritoneal dialysis (PD) is an effective treatment for end-stage kidney disease; the literature supports PD as having a more beneficial effect on residual renal function and on patient’s quality of life and it offers several advantages in comparison to to tradition hemodialysis renal replacement. ( 2 ) Drawbacks of PD include the need for surgery and anesthetic induction for catheter placement, the need for PD to be performed daily, and requirement of an external catheter, which some patients may find cosmetically unappealing. ( 1 , 4 ) Placement of a functioning catheter is essential. The main catheter related complications can include peritonitis, infection, catheter outflow obstruction, leakage, and migration, which hinder optimal functioning of the PD catheter. These complications can lead to catheter displacement or even loss of peritoneal access. ( 3 – 5 ) Surgical techniques for catheter placement include open laparotomy, percutaneous puncture, and laparoscopic technique. Every step of this described approach to achieve optimal catheter placement and promote long-term catheter function. ( 6 ) New catheter placement procedures have evolved due to progress in minimally invasive surgery and nowadays laparoscopic placement of peritoneal dialysis catheter is a widely accepted and effective technique with minimal complications. Meta-analysis shows the laparoscopic procedure as a superior catheter placement procedure with lower incidences of catheter malfunction; the laparoscopic technique compared with open surgery reduces morbidity, duration of hospital stay, postoperative pain and recovery. ( 1 – 5 ) Adhesiolysis, omentum section, and mobilization of the loops may be necessary to optimize the procedure. ( 4 ) In this article we describe step by step our technique that offers a safe and standardized reproducible method for minimally invasive placement of peritoneal dialysis catheters. This is a fully illustrated description with figures and intraoperative photographs to highlight and emphasize key anatomy and critical surgical steps ( 1 ) SURGICAL TECHNIQUE In our experience we have used soft silicone catheters, with a multi-hole pig-tail distal end to be placed in the Douglas cul-de-sac and a proximal end with two Dacron® cuffs one of which is placed in the preperitoneal space and the other in the subcutaneous space. ( 1 – 5 ) We placed the catheter on the right side of the abdomen to accommodate the peristalsis; the peristalsis results in clockwise movement of the ileal loops so a left-sided catheter could be easily displaced The procedures were all performed by the same surgical team. After general endotracheal tube anesthesia induction, the skin is prepped with chlorhexidine scrub and an adhesive Betadine skin barrier is placed. The Betadine skin barrier serves as an added precaution to ensure that direct contact between the PD catheter and the skin does not occur. ( 4 – 5 ) Antibiotic prophylaxis with cefazolin is performed 30–60 minutes before the skin incision. The patient empties the bladder immediately before surgery and is placed in supine position with legs closed with shoulder supports and both arms along the body. ( 4 – 5 ) The laparoscopic rack is positioned to the right of the patient, the operator and the assistant are positioned to the left. Abdominal access is performed with the T.U.O.L. technique, through a 1.5-2 cm transverse skin incision on the lower edge of the umbilical scar and subsequent introduction of the 10 mm Hasson trocar. Once insufflation has been performed, first we examined peritoneal cavity then we position the patient in Trendelenburg for a better pelvic exposure. Two 5-mm trocars are inserted, all under direct vision, according to the patient’s habitus, in the left ipocondrium and in the left iliac fossa; these trocars should be positioned equidistant from each other and from the umbilicus. (Fig. 1 ) If necessary we performed adhesiolisys with energy device and we place additional trocars. A 7mm trocar is inserted in the right side of the abdomen, medial to the epigastric vessels, about 3 cm laterally and inferior to the umbilicus, with a 2cm preperitoneal tunnelling and we insert the catheter into the abdomen up to the limit shown by the first Dacron cuff. The distal part of the catheter is placed in the pouch of Douglas and fixed right in the pelvis with a peritoneal tie obtained by constant suture 5 cm long with barbed non-absorbable thread 2/0 (Fig. 2 ,3) However, this solution allows its removal without necessarily having to reoperate the patient. At the end, a subcutaneous tunnel is created with an appropriate tunnelling kit (tunnelizer). The outer Dacron cuff remains completely subcutaneous lateral to the inner cuff. The PD catheter exit site on the skin is placed about 2–4 cm laterally from the subcutaneous cuff. (1–7) Correct inflow and outflow will be tested with at least 500 ml of saline with the patient in the neutral position. Umbilical access muscle fascia is sutured with absorbable suture long term. Skin closure is performed with absorbable sutures. Patients are discharged safely on the first postoperative day. (1–7) The nephrologist is responsible for catheter management and break-in to peritoneal dialysis. RESULTS We performed 35 procedures from October 2019 to June 2023. 13 patients were women and 22 were men with an average age of 46 years. This technique showed 91% success rate for catheter placement with average operative time of 45 minutes with 0% mortality rate. The 30-day morbidity was 8% including one patient with intrabdominal bleendin wich did not require surgical revision. During the follow-up, an incisional hernia was reported in 3 patients: a catheter was removed after 12 months because of non-antibiotic treatable peritonitis. Malfunctioning occurred in 4 cases, one patient with inflow and tree patients with outflow obstruction: in the all case, we performed a laparoscopic second look for adhesiolysis; while in the latter case, we removed the catheter for a complex adhesional syndrome. In a female patient, we removed a bulky right ovarian teratoma during the procedure. No omentopexy or omentectomy was performed in any of our patients, which may be related to the small sample size. Ten of the 35 patients underwent renal transplant. For those patients, peritoneal dialysis was a bridge to surgery. CONCLUSION A optimal PD catheter placement technique is necessary to provide patients with the highest chance of success. (7) We believe that our laparoscopic peritoneal catheter placement and fixation technique is simple, highly reproducible and safe. We describes rational for each step. Our findigs include low complication rates and good catheter seal in the short and medium term:higher one-year catheter survival and less migration. Declarations Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The authors affirm that human research participants provided informed consent for participate Consent for publication The authors affirm that human research participants provided informed consent for publication Data Availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Competing Interests The author declare no conflict Funding No funding was received to assist with the preparation of this manuscript. Author’s contributions G.O. and P.S. wrote the main manuscript text and C.S prepared figures 1-3. All authors reviewed the manuscript. All author have approved the submitted version (and any substantially modified version that involves the author's contribution to the study) and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature References Brandon M. Smith, MD,1,2 and Adrian G. Dan, MD, FACS, FASMBS1,2. OPERATIVE TECHNIQUE FOR LAPAROSCOPIC PLACEMENT OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETER. Journal Of Laparoendoscopic & Advanced Surgical Techniques Volume 00, Number 00, 2020 Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, Abdel-Aal A, Cullis B, Goh BL, Briggs VR, Brown EA, Dor FJMF. CREATING AND MAINTAINING OPTIMAL PERITONEAL DIALYSIS ACCESS IN THE ADULT PATIENT: 2019 UPDATE. Perit Dial Int. 2019 Sep-Oct;39(5):414-436. Htay H, Johnson DW, Craig JC, Schena FP, Strippoli GF, Tong A, Cho Y. CATHETER TYPE, PLACEMENT AND INSERTION TECHNIQUES FOR PREVENTING CATHETER-RELATED INFECTIONS IN CHRONIC PERITONEAL DIALYSIS PATIENTS. Cochrane Database Syst Rev. 2019 May Shen Q, Jiang X, Shen X, Yu F, Tu Q, Chen W, Ye Q, Behera TR, He Q. MODIFIED LAPAROSCOPIC PLACEMENT OF PERITONEAL DIALYSIS CATHETER WITH INTRA-ABDOMINAL FIXATION. Int Urol Nephrol. 2017 Aug;49(8):1481-1488. Janez J. LAPAROSCOPICALLY ASSISTED INSERTION OF PERITONEAL DIALYSIS CATHETER. J Minim Access Surg. 2019 Jan-Mar;15(1):80-83. Guilbert A, Benoit O, Lupinacci RM. LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER INSERTION. J Visc Surg. 2023 Feb;160(1):60-64. Gao X, Peng Z, Li E, Tian J. MODIFIED MINIMALLY INVASIVE LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER INSERTION WITH INTERNAL FIXATION. Ren Fail. 2023 Dec;45(1):2162416. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4283193","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295045324,"identity":"d8628834-a0f9-46ea-8124-47436f2d089e","order_by":0,"name":"Giuseppina Oliva","email":"","orcid":"","institution":"OSPEDALE SANTA MARIA DELLA PIETA' - ASLNAPOLI3SUD","correspondingAuthor":false,"prefix":"","firstName":"Giuseppina","middleName":"","lastName":"Oliva","suffix":""},{"id":295045325,"identity":"a1ad97da-3b14-45fe-886c-73f4f20dcf43","order_by":1,"name":"Sorrentino Carmen","email":"","orcid":"","institution":"OSPEDALE SANTA MARIA DELLA PIETA' - ASLNAPOLI3SUD","correspondingAuthor":false,"prefix":"","firstName":"Sorrentino","middleName":"","lastName":"Carmen","suffix":""},{"id":295045327,"identity":"5f1aac05-0034-4bed-ade2-f0089be798ae","order_by":2,"name":"Santella Gianluigi","email":"","orcid":"","institution":"OSPEDALE SANTA MARIA DELLA PIETA' - ASLNAPOLI3SUD","correspondingAuthor":false,"prefix":"","firstName":"Santella","middleName":"","lastName":"Gianluigi","suffix":""},{"id":295045329,"identity":"b6420568-6c8c-441f-9d81-497dea250a16","order_by":3,"name":"Lombardi Guido","email":"","orcid":"","institution":"OSPEDALE SANTA MARIA DELLA PIETA' - ASLNAPOLI3SUD","correspondingAuthor":false,"prefix":"","firstName":"Lombardi","middleName":"","lastName":"Guido","suffix":""},{"id":295045331,"identity":"354d65f7-42d3-4363-bf7d-f058e1f93da0","order_by":4,"name":"Sullo Pasquale","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYLCCBwUMcgwMzA0gtgwbP5DmYZDAryXBgMGYgYERrIWHTeIAWAt+PUAtiQ0wLUAumMSpxZyB/ZlEgoFNen//wbYHP3fY8PAxHH8m8YbBog6XFssGHjOglrTcGTcS2w17z6TxsDH3mEnOweMwgwNAxycYHM5tuMHYJsHbdpiHjeEMmzQ+vxgcADvscLr8+YNtkn/BWtKfEdDCAHLY4QSDA4lt0hBbEszwarFs5jG2APrFcOMNoBZZkF8kzhhbzjGQkGzAocWcvf3hjQ8VNvJy5w8fk3y7w0ZOvh8o8qaijh+nw5iReYxwkw1waUCXQmgZBaNgFIyCUYAAACs4TDjYlk1JAAAAAElFTkSuQmCC","orcid":"","institution":"OSPEDALE SANTA MARIA DELLA PIETA' - ASLNAPOLI3SUD","correspondingAuthor":true,"prefix":"","firstName":"Sullo","middleName":"","lastName":"Pasquale","suffix":""}],"badges":[],"createdAt":"2024-04-17 16:29:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4283193/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4283193/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55526816,"identity":"9e6f085a-0525-490e-a2d8-f0ffa815449f","added_by":"auto","created_at":"2024-04-29 14:57:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":293812,"visible":true,"origin":"","legend":"\u003cp\u003eTrocars and PD catheter placement\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4283193/v1/ad3cb446aad6ea181aa8472a.png"},{"id":55526820,"identity":"903845a5-bd02-4de1-b41e-80f85db00b84","added_by":"auto","created_at":"2024-04-29 14:57:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":147897,"visible":true,"origin":"","legend":"\u003cp\u003eMaking of the peritoneal tie with barbed suture.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4283193/v1/f25c5d3c8d4363e9421a6079.png"},{"id":55527499,"identity":"81226793-a728-4e90-9c9b-1b26c00da1c2","added_by":"auto","created_at":"2024-04-29 15:05:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":154922,"visible":true,"origin":"","legend":"\u003cp\u003ePD catheter in appropriate position in woman pelvis and peritoneal tie\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4283193/v1/9d044d42080b01f3cd3d30be.png"},{"id":59935281,"identity":"81b1e48e-9423-4cdb-b0eb-dc43379e676c","added_by":"auto","created_at":"2024-07-09 13:47:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1039951,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4283193/v1/d0b48816-16f2-46e6-b811-b556f628aaca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Peritoneal Tie Technique: Our Laparoscopic Catheter Placement for Peritoneal Dialysis\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePeritoneal dialysis (PD), first described as a long-term management modality for end-stage renal disease (ESRD) in 1976, is becoming an increasingly utilized method for renal replacement therapy\u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePeritoneal dialysis (PD) is an effective treatment for end-stage kidney disease; the literature supports PD as having a more beneficial effect on residual renal function and on patient\u0026rsquo;s quality of life and it offers several advantages in comparison to to tradition hemodialysis renal replacement.\u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eDrawbacks of PD include the need for surgery and anesthetic induction for catheter placement, the need for PD to be performed daily, and requirement of an external catheter, which some patients may find cosmetically unappealing.\u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePlacement of a functioning catheter is essential. The main catheter related complications can include peritonitis, infection, catheter outflow obstruction, leakage, and migration, which hinder optimal functioning of the PD catheter. These complications can lead to catheter displacement or even loss of peritoneal access.\u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eSurgical techniques for catheter placement include open laparotomy, percutaneous puncture, and laparoscopic technique. Every step of this described approach to achieve optimal catheter placement and promote long-term catheter function. \u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eNew catheter placement procedures have evolved due to progress in minimally invasive surgery and nowadays laparoscopic placement of peritoneal dialysis catheter is a widely accepted and effective technique with minimal complications.\u003c/p\u003e\n\u003cp\u003eMeta-analysis shows the laparoscopic procedure as a superior catheter placement procedure with lower incidences of catheter malfunction; the laparoscopic technique compared with open surgery reduces morbidity, duration of hospital stay, postoperative pain and recovery. \u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAdhesiolysis, omentum section, and mobilization of the loops may be necessary to optimize the procedure. \u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn this article we describe step by step our technique that offers a safe and standardized reproducible method for minimally invasive placement of peritoneal dialysis catheters. This is a fully illustrated description with figures and intraoperative photographs to highlight and emphasize key anatomy and critical surgical steps\u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e"},{"header":"SURGICAL TECHNIQUE","content":"\u003cp\u003eIn our experience we have used soft silicone catheters, with a multi-hole pig-tail distal end to be placed in the Douglas cul-de-sac and a proximal end with two Dacron\u0026reg; cuffs one of which is placed in the preperitoneal space and the other in the subcutaneous space. \u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWe placed the catheter on the right side of the abdomen to accommodate the peristalsis; the peristalsis results in clockwise movement of the ileal loops so a left-sided catheter could be easily displaced\u003c/p\u003e\n\u003cp\u003eThe procedures were all performed by the same surgical team.\u003c/p\u003e\n\u003cp\u003eAfter general endotracheal tube anesthesia induction, the skin is prepped with chlorhexidine scrub and an adhesive Betadine skin barrier is placed. The Betadine skin barrier serves as an added precaution to ensure that direct contact between the PD catheter and the skin does not occur. \u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAntibiotic prophylaxis with cefazolin is performed 30\u0026ndash;60 minutes before the skin incision. The patient empties the bladder immediately before surgery and is placed in supine position with legs closed with shoulder supports and both arms along the body. \u003csup\u003e(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe laparoscopic rack is positioned to the right of the patient, the operator and the assistant are positioned to the left.\u003c/p\u003e\n\u003cp\u003eAbdominal access is performed with the T.U.O.L. technique, through a 1.5-2 cm transverse skin incision on the lower edge of the umbilical scar and subsequent introduction of the 10 mm Hasson trocar.\u003c/p\u003e\n\u003cp\u003eOnce insufflation has been performed, first we examined peritoneal cavity then we position the patient in Trendelenburg for a better pelvic exposure.\u003c/p\u003e\n\u003cp\u003eTwo 5-mm trocars are inserted, all under direct vision, according to the patient\u0026rsquo;s habitus, in the left ipocondrium and in the left iliac fossa; these trocars should be positioned equidistant from each other and from the umbilicus. (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eIf necessary we performed adhesiolisys with energy device and we place additional trocars.\u003c/p\u003e\n\u003cp\u003eA 7mm trocar is inserted in the right side of the abdomen, medial to the epigastric vessels, about 3 cm laterally and inferior to the umbilicus, with a 2cm preperitoneal tunnelling and we insert the catheter into the abdomen up to the limit shown by the first Dacron cuff.\u003c/p\u003e\n\u003cp\u003eThe distal part of the catheter is placed in the pouch of Douglas and fixed right in the pelvis with a peritoneal tie obtained by constant suture 5 cm long with barbed non-absorbable thread 2/0 (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e,3)\u003c/p\u003e\n\u003cp\u003eHowever, this solution allows its removal without necessarily having to reoperate the patient.\u003c/p\u003e\n\u003cp\u003eAt the end, a subcutaneous tunnel is created with an appropriate tunnelling kit (tunnelizer). The outer Dacron cuff remains completely subcutaneous lateral to the inner cuff. The PD catheter exit site on the skin is placed about 2\u0026ndash;4 cm laterally from the subcutaneous cuff. \u003csup\u003e(1\u0026ndash;7)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eCorrect inflow and outflow will be tested with at least 500 ml of saline with the patient in the neutral position.\u003c/p\u003e\n\u003cp\u003eUmbilical access muscle fascia is sutured with absorbable suture long term. Skin closure is performed with absorbable sutures. Patients are discharged safely on the first postoperative day. \u003csup\u003e(1\u0026ndash;7)\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe nephrologist is responsible for catheter management and break-in to peritoneal dialysis.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWe performed 35 procedures from October 2019 to June 2023. 13 patients were women and 22 were men with an average age of 46 years. This technique showed 91% success rate for catheter placement with average operative time of 45 minutes with 0% mortality rate.\u003c/p\u003e \u003cp\u003eThe 30-day morbidity was 8% including one patient with intrabdominal bleendin wich did not require surgical revision.\u003c/p\u003e \u003cp\u003eDuring the follow-up, an incisional hernia was reported in 3 patients: a catheter was removed after 12 months because of non-antibiotic treatable peritonitis.\u003c/p\u003e \u003cp\u003eMalfunctioning occurred in 4 cases, one patient with inflow and tree patients with outflow obstruction: in the all case, we performed a laparoscopic second look for adhesiolysis; while in the latter case, we removed the catheter for a complex adhesional syndrome.\u003c/p\u003e \u003cp\u003eIn a female patient, we removed a bulky right ovarian teratoma during the procedure.\u003c/p\u003e \u003cp\u003eNo omentopexy or omentectomy was performed in any of our patients, which may be related to the small sample size. Ten of the 35 patients underwent renal transplant. For those patients, peritoneal dialysis was a bridge to surgery.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eA optimal PD catheter placement technique is necessary to provide patients with the highest chance of success. \u003csup\u003e(7)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe believe that our laparoscopic peritoneal catheter placement and fixation technique is simple, highly reproducible and safe.\u003c/p\u003e \u003cp\u003eWe describes rational for each step. Our findigs include low complication rates and good catheter seal in the short and medium term:higher one-year catheter survival and less migration.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u0026nbsp;The authors affirm that human research participants provided informed consent for participate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human research participants provided informed consent for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declare no conflict\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eG.O. and P.S. wrote the main manuscript text and C.S prepared figures 1-3. All authors reviewed the manuscript. All author have approved the submitted version (and any substantially modified version that involves the author's contribution to the study) and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBrandon M. Smith, MD,1,2 and Adrian G. Dan, MD, FACS, FASMBS1,2. OPERATIVE TECHNIQUE FOR LAPAROSCOPIC PLACEMENT OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETER. \u003cem\u003eJournal Of Laparoendoscopic \u0026amp; Advanced Surgical Techniques Volume 00, Number 00, 2020\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eCrabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, Abdel-Aal A, Cullis B, Goh BL, Briggs VR, Brown EA, Dor FJMF. CREATING AND MAINTAINING OPTIMAL PERITONEAL DIALYSIS ACCESS IN THE ADULT PATIENT: 2019 UPDATE.\u0026nbsp;Perit Dial Int. 2019 Sep-Oct;39(5):414-436.\u003c/li\u003e\n \u003cli\u003eHtay H, Johnson DW, Craig JC, Schena FP, Strippoli GF, Tong A, Cho Y. CATHETER TYPE, PLACEMENT AND INSERTION TECHNIQUES FOR PREVENTING CATHETER-RELATED INFECTIONS IN CHRONIC PERITONEAL DIALYSIS PATIENTS. Cochrane Database Syst Rev. 2019 May\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShen Q, Jiang X, Shen X, Yu F, Tu Q, Chen W, Ye Q, Behera TR, He Q. MODIFIED LAPAROSCOPIC PLACEMENT OF PERITONEAL DIALYSIS CATHETER WITH INTRA-ABDOMINAL FIXATION. Int Urol Nephrol. 2017 Aug;49(8):1481-1488.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJanez J. LAPAROSCOPICALLY ASSISTED INSERTION OF PERITONEAL DIALYSIS CATHETER. J Minim \u0026nbsp;Access Surg. 2019 Jan-Mar;15(1):80-83.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGuilbert A, Benoit O, Lupinacci RM. LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER INSERTION. J Visc Surg. 2023 Feb;160(1):60-64.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\n \u003cform\u003eGao X, Peng Z, Li E, Tian J. MODIFIED MINIMALLY INVASIVE LAPAROSCOPIC PERITONEAL DIALYSIS CATHETER INSERTION WITH INTERNAL FIXATION. Ren Fail. 2023 Dec;45(1):2162416.\u003c/form\u003e\n \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"peritoneal dialysis, laparoscopic catheter placement, fixation peritoneal","lastPublishedDoi":"10.21203/rs.3.rs-4283193/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4283193/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePeritoneal dialysis (PD) is a safe and effective replacement therapy for patients with terminal stage renal disease, alternative to hemodialysis. However, its success depends on the placement of a peritoneal catheter with a safe, functional and durable access. Currently, several techniques are put into practice for peritoneal catheter placement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe present a detailed stepwise description of our operative technique for PD catheter placement. This description is combined with intraoperative photographs to highlight key steps.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ewe describes potential pitfalls that may prevent optimal catheter function and We report our results in the medium and short term\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis technique performe safely and standardized reproducible method for minimally invasive placement of peritoneal dialysis catheters,\u003c/p\u003e","manuscriptTitle":"The Peritoneal Tie Technique: Our Laparoscopic Catheter Placement for Peritoneal Dialysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 14:57:39","doi":"10.21203/rs.3.rs-4283193/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ff5940d-4b26-48b3-997e-548f44af7cdc","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-09T13:39:08+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-29 14:57:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4283193","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4283193","identity":"rs-4283193","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}