Abstract
We introduce here an operative method of CAPD catheter insertion used in our hospital and report on complications which necessitated removal of the catheter. We should pay attention to certain points when surgically inserting a catheter. These points are: 1. use of the curl type (double cuff) Tenckhoff catheter. 2. insertion the curl portion of catheter into the Douglas pouch. 3. to make the minimum feasible laparotomy incision and to pursedouble suture tightly. 4. to keep a distance of 5-7cm from the 2nd cuff to the exit, and so on.
We experienced fouty-four CAPD catheter insertions in the ten years from 1981 to 1990. Fifteen catheter complications occurred in ten years, including seven poor drainages, one leakage of solution, two tunnel infections, two exit infections, one 2nd cuff erosion, and one case each of severe pain and bleeding in the peritoneal cavity. All fifteen complications necessitated removal of the catheter. After six poor drainages had ocurred with the straight type in the first seven years of the study, only one occurred while using the curl type in the last three years. Poor drainage is the main element of early complication, because most of our poor drainage problems occurred eighteen days or more after the insertion of the CAPD.
One patient experienced three episodes of serious complication in the course of four insertions (two tunnel infections and two exit infections). We expect that poor aseptic technique and an immunity disorder were partially responsible.
Most complications are prevented by attention to detail and careful technique during the surgical insertion. It is important that we constantly strive to improve the operative method.
