Paramedian insertion of Tenckhoff catheters with three purse-string sutures reduces the risk of leakage.

Starting peritoneal dialysis (PD) immediately after insertion of a peritoneal dialysis catheter is essential in some patients. However, due to a poor insertion technique, leakage may occur in up to 20% of patients after insertion of a peritoneal dialysis catheter, for example, in the midline. PD was started in 50 consecutive patients (age range 7-81 years). Under local anesthesia the Tenckhoff catheter was inserted about 3 cm lateral to the linea alba (mostly to the right) near the navel. The ventral and dorsal fasciae of the rectus muscle were split sagitally before entering the peritoneal membrane by a small incision. One purse-string suture fixed the peritoneal membrane around the inner cuff, while the second suture fixed the dorsal fascia of the rectus muscle around the outer side of the cuff. A third suture was placed around the catheter in the ventral fascia. Dialysis in all our patients was started peroperatively, initially by the use of 1 L of peritoneal dialysis fluid (Dianeal, Baxter Medical AB, Sweden). Bed rest for 2 or 3 days was requested of and performed by most patients. Only one early and no late leakages occurred. At reoperation of the patient with the leak, the second suture was found to have been loosened. The technique is easy to handle and enables immediate dialysis. The risk for leakage is very low.