Surgical considerations of continuous ambulatory peritoneal dialysis.

The surgical considerations pertaining to 173 continuous ambulatory peritoneal dialysis catheters were reviewed in 140 patients from 1979 through 1983. All catheters were inserted in the operating suite by an open technique. Local anesthesia was used in the majority of patients (59%). Catheter peritonitis was the most frequent complication, 228 episodes/2407 patient months. Twenty-three percent of the patients accounted for 51% of catheter-related peritonitis. Sixteen catheters were removed because of an inability to clear the infection. Intra-abdominal catastrophes were noted in four patients and differentiation from continuous ambulatory peritoneal dialysis peritonitis was based on serial examinations, bacteriologic cultures, and/or a progressive increase in free abdominal air. Surgically-related catheter complications were designated either early (less than 1 month) or late (greater than 1 month) in relation to catheter placement. Frequent early complications were mechanical flow problems and dialysate leaks. Five of 11 mechanical flow difficulties required catheter replacement while none of the dialysate leaks required surgical intervention, and all healed spontaneously. Common late complications included 35 tunnel infections, 23 of which were associated with peritonitis. Nine of these catheters (25%) were removed. Cuff extrusion was also associated with a high incidence (83%) of catheter attrition. Thirty-six patients underwent renal transplantation and in no instance did the catheter increase patient or renal allograft morbidity rates.