Three purse-string sutures allow immediate start of peritoneal dialysis with a low incidence of leakage.

Peritoneal dialysis (PD) depends to a great extent on a well-functioning dialysis catheter. The number of patients choosing PD also depends on the possibility of starting dialysis with this technique without needing to use hemodialysis (HD) intermediate or in the beginning of the procedure. This review describes various insertion techniques focusing on a surgical insertion technique using purse-string sutures to fix the peritoneum around the catheter with the inner cuff of a Tenckhoff catheter invaginated between purse-string sutures of the peritoneal membrane and the inner rectus muscle fascia. A third purse-string suture is used to fix the catheter and to tighten the hole in the external rectus fascia. This technique enables immediate start of PD with only a limited risk for early and late leakage. Similar fixation sutures could be considered when inserting catheters, using other insertion modes, to tighten the hole and the position of the cuff and the catheter.