Gadallah MF, Pervez A, El-Shahawy M, Sorrells D, Zibari G,
McDonald J, Work J
Peritoneoscopic versus surgical placement of Tenckhoff
catheters: a prospective study on outcome
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1428 1996
Gadallah et al performed a prospective randomized study on 132 PD patients
comparing surgical and
peritoneoscopic placement. A double cuff curled Tenchkoff catheter was used
and randomization was
on the basis of month by month rotation. No different baseline differences
were detected between
the two groups. The peritoneoscopically placed catheters had a significantly
better survival [60%
versus 48% at 12 months and 48% versus 41% at 24 months]. Early infection
was also less frequent in
the peritoneoscopic group [2.6% versus 12.7%]. Other complications did not
differ. The conclusion
was that peritoneoscopically placed catheters were superior.
Comment: This important study confirms previous suggestions that
peritoneoscopically placed
catheters do better. A particular benefit was less early exit site infection
although,
interestingly, leaks and late infection did not differ between the two
groups. A concern with all
such studies is that differences are more dependent on the operator,
especially when only one or two
centres are involved, as is the case in this study. There might also be some
concern about the
method of randomization but, overall, this is a very useful and important
finding and adds strongly
to the argument for routine use of peritoneoscopy in catheter placement.
(Peter G. Blake, M.D.,
Victoria Hospital, London, Ontario)
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Am Soc Nephrol
Basic peritoneal dialysis :
PD catheters