The surgeon's role in chronic peritoneal dialysis.

Hemodialysis has been the mainstay for children with end-stage renal disease until a successful renal transplant is accomplished. Chronic peritoneal dialysis has been a second choice and, in special circumstances such as for small infants, children without vascular access, or patients unstable on hemodialysis, it is the only alternative. Recent refinements in peritoneal catheters and dialysis have added to the many medical, psychological, and economic advantages, resulting in the displacement of hemodialysis by peritoneal dialysis as the most frequently used modality. Forty-six patients were followed for 593 catheter months on peritoneal dialysis. A total of 74 procedures were performed, and 56 catheters were implanted. Complications included infection and mechanical occlusion of the catheter. Peritonitis occurred in 13 of the 46 patients on 56 separate occasions. There were 5 episodes of subcutaneous catheter infection. The peritonitis was treated with medical therapy alone in 50 of the 56 episodes of peritonitis. Mechanical occlusion in 10 patients and remedial surgery was required in 9. Of the total series, 4 patients were returned to hemodialysis and 5 patients died. Based on this experience we have developed guidelines to assist the surgeon in preventing and treating the various complications associated with chronic peritoneal dialysis.