The effects of peritoneal dialysis catheter insertion using paramedian versus midline approach on CAPD patients.

OBJECTIVE: Types of peritoneal dialysis (PD) catheter design and catheter insertion techniques have been shown to affect catheter-associated infection, catheter survival, as well as, overall patient survival. Thus far, there have been no studies demonstrating a difference in long term outcome between two insertion techniques used for PD placement, including midline and paramedian incisions. The present study was conducted to compare clinical outcomes among CAPD patients who had bedside PD catheter insertion through midline incision vs. paramedian incision in terms of early post-operative complications and long term outcomes.

MATERIAL AND METHOD: This is a retrospective study. All CAPD patients who received treatments at Maharat Nakhonratchasima Hospital during the year 2008-2010 were included in the present study. Age, sex, co-morbid diseases, laboratory results obtained prior to dialysis, early post-operative complications, and late post-operative complications were documented.

RESULTS: A total of 392 patients were identified. Of these, 43 patients were excluded due to incomplete medical records. The remaining 349 cases were collected for analysis, 90 cases having paramedian incision and 259 cases having midline incision. The average age was 51.7 years old, and 52% were male. The baseline characteristics and patient parameters were similar in both approaches. The paramedian group was found to have lesser early post-operative complications (7.78%) when compared to the midline group (18.82%) (p = 0.02). Moreover, the long term outcomes were shown to be greater in paramedian approach when compared to the midline group in terms of PD catheter survival (985.5 vs. 698.1 days, p = 0.048) and overall patient survival (915.4 vs. 700.6 days, p = 0.01). However, there was no significant difference in peritonitis-free survival (848.7 vs. 824.3 days, p = 0.93).

CONCLUSION: Comparing PD catheter insertion using paramedian incision with midline incision, paramedian incision was associated with less early post operative complications, more prolonged PD catheter survival and better overall patient survival. Therefore, paramedian incision should be recommended as the preferred method for PD catheter insertion.