Surgical aspects of continuous ambulatory peritoneal dialysis in infants, children and adolescents.

The importance of surgical contributions to successful pediatric continuous ambulatory peritoneal dialysis demonstrated in this review of our experience with 9 pediatric patients maintained on such dialysis for 2 to 21 months (mean 11.3 months). Specific surgical procedures for pediatric peritoneal catheter placement have been developed that ensure proper catheter position, establish a watertight seal at the peritoneum and provide for intraoperative demonstration of good catheter function. Peritoneography at the time of catheter placement had predicted accurately later clinical hernia development and may be used to repair prophylactically subclinical inguinal and umbilical defects that are only demonstrable by intraoperative peritoneography. Partial omentectomy also has been helpful in certain instances. Since institution of the techniques described in this report, our 9 young patients have accumulated 101 patient-months on continuous ambulatory peritoneal dialysis without a single catheter failure. The benefits of this as yet unrestricted extension of peritoneal catheter functional life span may be attributed to the catheter-protective features of the continuous ambulatory peritoneal dialysis method itself and the involvement of interested surgeons as active members of the pediatric continuous ambulatory peritoneal dialysis program.