1996 Volume 29 Issue 10 Pages 1387-1392
Major causes of drop-outs from CAPD treatment include peritonitis and catheter-related problems. Recently, it was reported that catheter-related problems, such as persistent exit-site infections and/or chronic tunnel infections, are often precursors of peritonitis and causes of catheter loss. Several therapeutic approaches, for example administration of antibiotics, unroofing and cuff shaving, have been advocated but the results of these therapies are not yet satisfactory. Thus, we have devised a new surgical approach for persistent exit-site infections and/or chronic tunnel infections of CAPD. In this procedure, there are four important steps; 1) the infectious tissue around the exit-site and superficial cuff is removed with the CAPD catheter including the superficial cuff (not shown in this study, but confirmed histopathologically), 2) with a titanium-extender (Accurate Surgical Co.) the original catheter is connected to a new one which has a new cuff, 3) the titaniumextender is put straight into the wound through the new tunnel, 4) a new exit-site is created just below the original one.
We applied this new approach in 4 patients. Three patients had both persistent exit-site infections and chronic tunnel infections of CAPD, the other only persistent exit-site infections. Neither catheter problems nor recurrence of exit-site infections and/or tunnel infections has occurred in the 56 months, to date, since this procedure was initially performed.
We conclude that this new approach is a useful and efficient treatment for persistent exit-site infections and chronic tunnel infections of CAPD and that it prolongs catheter survival time.
