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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Continuous ambulatory peritoneal dialysis &#40;PD&#41; has become an established option for treating patients with end-stage renal disease&#46; This therapy requires the insertion of a permanent PD catheter&#46; An estimated 25&#37; of the world population on PD lives in Latin America&#46; In particular&#44; Mexico is the country with the highest use of this technique in the world&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">PD catheters are inserted using various techniques&#46; Open surgical approaches can involve midline&#44;<span class="elsevierStyleSup">2-4</span> paramedian infra-umbilical laparotomy<span class="elsevierStyleSup">5&#44;6</span> or multiple laparoscopic approaches&#46;<span class="elsevierStyleSup">7-10</span> Although laparoscopy has become the surgical method of choice for placing PD catheters&#44; open surgery techniques remain as an important option when laparoscopic resources are limited&#44; whether due to the <span class="elsevierStyleBold">lack of laparoscopic equipment in different hospitals</span> due to costs&#44; or due to operator limitations&#46;</p><p class="elsevierStylePara">Complications associated with PD contribute significantly to morbidity and mortality rates&#44; interruption of treatment&#44; and decreased efficacy of dialysis&#44; in addition to causing the need for conversion to haemodialysis&#44; hospitalisation&#44; and subsequent surgeries&#46; Early and late complications such as surgical wound infection&#44; peritonitis&#44; and catheter dysfunction due to migration&#44; obstruction&#44; bleeding&#44; granuloma&#44; or post-incisional hernia limit the long-term survival of the PD catheter in 35&#37;-51&#37; of cases after 24 months&#46;<span class="elsevierStyleSup">11</span> An 80&#37; catheter survival rate after one year has been recommended as a target for PD centres&#44;<span class="elsevierStyleSup">5&#44;8&#44;12</span> and can be reached using the most economical resources available and techniques appropriate for each PD unit&#46; With the goal of minimising morbidity rates associated with this therapy&#44;<span class="elsevierStyleSup">13</span> it is important to take into account patient characteristics that increase the risk of developing complications&#44; making an examination of pre-existing conditions necessary&#46;</p><p class="elsevierStylePara">Several studies associated complications with different factors including age&#44; gender&#44; diabetes&#44; sepsis&#44; prolonged duration of surgery&#44; and previous abdominal surgery<span class="elsevierStyleSup">5&#44;14-17</span>&#46; Several authors observed that an omentectomy and&#47;or omental wrapping prevents catheter dysfunction&#44; while other studies showed no correlation between previous omentectomy or abdominal surgery and postoperative complications&#46;<span class="elsevierStyleSup">3&#44;7&#44;18-20</span></p><p class="elsevierStylePara">The aim of this article was to present the results from our experience in the insertion of PD catheters and to determine which factors involve a higher risk for early catheter dysfunction and affect 1-year survival rates&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHODS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We performed a retrospective review of clinical histories from patients with end-stage renal disease that underwent open surgery for catheter placement in preparation for the start of PD&#46;</p><p class="elsevierStylePara">All procedures were performed by a single surgeon between January 2004 and January 2010&#46; Demographical data&#44; patient characteristics&#44; surgical records&#44; and catheter complications during the first year requiring catheter replacement were collected and analysed&#46; We received approval from the Institutional Review Board and the Bioethics Committee for data collection and analysis&#44; respectively&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Surgical procedure</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Each patient was administered cefotaxime &#40;1g intravenously in a single dose&#41; for preoperative prophylaxis&#46; All catheters used were standard Dacron double-cuff straight Tenckhoff catheters&#46; Anaesthetic technique was determined on a case-by-case basis by the attending anaesthesiologist&#46; Each catheter was inserted by mini-laparotomy through a vertical midline infra-umbilical incision of approximately 3cm-4cm&#46; The peritoneum was exposed using an open surgical technique&#44; and the catheter was placed directly in the pelvic cavity&#46; After placement&#44; the internal cuff was joined to the peritoneum with a 2&#47;0 chromic suture and permeability was verified&#46; The linea alba was closed using size 1 polyglycolic acid suture&#46; The catheter was removed from the peritoneal cavity through the wound&#44; and the end of the catheter was tunnelled subcutaneously&#44; passing through the skin in a small para-umbilical incision with the external Dacron cuff in the subcutaneous tissue&#46; The subcutaneous tissue and skin were closed using standard procedure&#46; Dialysate solution was immediately infused into the peritoneal cavity while in the operating room in order to ensure there was no leakage of dialysate fluid&#46; The decision to perform an omentectomy was left to the surgeon&#8217;s judgement&#44; depending on whether the omentum was accessible through the incision&#44; the size of the omentum&#44; and whether it could reach the catheter and obstruct it&#46; Recently &#40;since 2010&#41;&#44; omentopexy has been performed using the same criteria as omentectomy&#46; Omentopexy involves anchoring the omentum to the abdominal wall above the infra-umbilical incision with interrupted absorbable sutures &#40;2&#47;0 chromic&#41; from the omentum to the peritoneum wall and bilaterally around the navel&#46; The majority of patients started on PD within 24 hours of catheter placement&#44; <span class="elsevierStyleBold">using continuous ambulatory PD with a predetermined infusion volume of 2000cc in all cases</span>&#46; Catheter replacement was requested by the nephrology department&#44; once salvage treatment was determined to have failed&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We performed a simple descriptive analysis of the data&#46; Categorical variables were described using proportions&#44; and continuous variables with a normal distribution were described using mean &#40;standard deviation&#41;&#46; We used Student&#8217;s t-tests and Mann-Whitney U-tests to evaluate differences for catheter dysfunction between continuous variables with normal and non-normal distribution&#44; respectively&#46; Categorical variables were analysed using chi-square tests or Fisher&#8217;s exact tests to identify variables associated with catheter dysfunction&#46; We determined odds ratios &#40;OR&#41; and created a logistic regression model in order to determine the risk factors in the univariate analysis&#46; We considered a <span class="elsevierStyleItalic">P</span>-value &#60;0&#46;05 to be statistically significant&#44; and used SPSS&#8482; software&#44; version 17&#46;0&#44; for all statistical analyses &#40;SPSS&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient and surgical registry characteristics</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">During the study period&#44; a total of 235 patients were placed catheters &#40;118 women and 117 men&#41;&#46; Mean patient age was 51&#46;4&#177;17&#46;5 years &#40;range&#58; 13-86 years&#41;&#44; mean body mass index &#40;BMI&#41; was 26&#46;3&#177;4&#46;2kg&#47;m<span class="elsevierStyleSup">2</span> &#40;range&#58; 14&#46;4-40&#41;&#44; and mean body surface area<span class="elsevierStyleSup">21</span> &#40;BSA&#59; Mosteller&#41; was 1&#46;7&#177;0&#46;1m<span class="elsevierStyleSup">2</span> &#40;range&#58; 1&#46;06-2&#46;1&#41;&#46; Some 43&#37; of patients &#40;n&#61;101&#41; had diabetic nephropathy&#44; and only 3&#37; &#40;n&#61;7&#41; had autosomal dominant polycystic kidney disease&#46;</p><p class="elsevierStylePara">Forty-six of the 235 patients &#40;19&#46;6&#37;&#41; had a history of previous abdominal surgery&#46; Of these&#44; only 26 had previously undergone one surgical procedure before&#44; 12 patients had undergone two previous surgical procedures&#44; 4 had undergone three previous surgical procedures&#44; and 4 patients had undergone more than 3 previous surgical procedures&#46; Regional anaesthesia was used in 95&#46;8&#37; of cases &#40;n&#61;225&#41; during catheter placement&#59; and general and local anaesthesia protocols were used evenly &#40;2&#46;1&#37;&#44; n&#61;5 each&#41;&#46; Mean duration of surgery was 43&#46;7&#177;14 minutes &#40;range&#58; 15-120&#41;&#46; An omentectomy was performed in 37&#46;9&#37; of catheter placements &#40;n&#61;89&#41;&#44; and an omentopexy was performed in 10 patients &#40;4&#46;3&#37;&#41;&#46; <span class="elsevierStyleBold">Dialysis was started within 24 hours of catheter placement in 97&#37; of patients &#40;n&#61;230&#41;</span>&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Peritoneal dialysis catheter complications and results</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Catheter dysfunction that eventually required catheter replacement occurred in 47 patients &#40;20&#37;&#41;&#44; and 80&#37; of catheters were incident-free after one year&#46;</p><p class="elsevierStylePara">Catheter dysfunction appeared after a mean 6&#46;8&#177;22&#46;6 days &#40;range&#58; 0-120&#41;&#46; The most common causes of catheter dysfunction were migration &#40;4&#46;3&#37;&#44; n&#61;10&#41; and peritonitis &#40;4&#46;3&#37;&#44; n&#61;10&#41;&#44; followed by obstruction of the catheter by omental wrapping in 9 patients &#40;3&#46;7&#37;&#41;&#46; Eight patients &#40;3&#46;4&#37;&#41; suffered surgical wound infection&#44; and all of them required catheter replacement at some point&#46; Other causes for changing the catheter included bleeding &#40;haemoperitoneum&#41; &#40;2&#46;1&#37;&#44; n&#61;5&#41; and fibrin clots in the catheter &#40;2&#46;1&#37;&#44; n&#61;5&#41;&#46; <span class="elsevierStyleBold">The 8 patients with surgical wound infections &#40;3&#46;4&#37;&#41; also had dialysate fluid leaks&#46; Four patients &#40;1&#46;7&#37;&#41; had only one dialysate fluid leak and did not require PD catheter replacement</span>&#46; Another complication that did not require catheter replacement was granuloma in the exit site with subcutaneous tunnel infection in 1&#46;7&#37; of patients &#40;n&#61;4&#41;&#46; Ten patients developed post-incisional hernias <span class="elsevierStyleBold">during the first year after catheter placement</span>&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Factors associated with catheter dysfunction</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We compared patients with and without catheter dysfunction&#44; searching for factors associated with this phenomenon &#40;Table 1&#41;&#46; Patients with dysfunction were younger&#44; with lower BMI and BSA than those without dysfunction &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; There were no differences between groups with and without diabetes and autosomal <span class="elsevierStyleBold">dominant</span> polycystic kidney disease&#46; We did not find any correlation between previous abdominal surgery and catheter dysfunction&#44; or the duration of the surgical procedure when using a 45-minute cut-off point&#46; Patients that underwent an omentectomy had a lower incidence of catheter dysfunction &#40;11&#46;2&#37;&#41; than patients that did not undergo an omentectomy &#40;25&#46;3&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;009&#41;&#46; We did not observe a similar association for omentopexy&#46; Patients that developed a post-incisional hernia developed catheter dysfunction in half of all cases &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;03&#41;&#44; and all patients with surgical wound infection required catheter replacement &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46; The logistic regression analysis showed that having undergone an omentectomy was a statistically significant protective factor against catheter dysfunction &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; No other variables that were significant in the univariate analysis for catheter dysfunction had a significant positive or negative impact on risk factors in the multivariate analysis &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our study showed a considerable level of effectiveness and safety in PD catheter placement using an open surgical approach with an infra-umbilical midline incision&#46; In addition&#44; certain patient variables&#44; such as age&#44; BMI&#44; BSA&#44; and surgical aspects&#44; such as wound infection and post-incisional hernia&#44; were associated with <span class="elsevierStyleBold">early</span> catheter dysfunction and catheter <span class="elsevierStyleBold">replacement</span>&#44; <span class="elsevierStyleBold">contrasting with the protective effect of an omentectomy&#44; which reduced the probability of catheter dysfunction</span>&#46;</p><p class="elsevierStylePara">We observed a wide range of complications that affected the incidence of catheter replacement&#46; The incidence of catheter migration &#40;4&#46;3&#37;&#41; was lower than that of 7&#46;6&#37; reported by Liu et al&#44;<span class="elsevierStyleSup">4</span> and those high rates &#40;22&#37;-24&#37;&#41; reported in other studies&#46;<span class="elsevierStyleSup">5&#44;8</span> In a similar manner&#44; omentum or fibrin obstruction occurred at a combined incidence of 5&#46;8&#37;&#44; lower or similar to rates reported in other studies&#46;<span class="elsevierStyleSup">4&#44;5</span></p><p class="elsevierStylePara">As regards infectious complications&#44; our rate of surgical wound infection was lower than in other studies&#44; and few patients in our study had peritonitis&#44; as compared to an unusual rate of 30&#37; reported in other studies&#46;<span class="elsevierStyleSup">3&#44;5</span> However&#44; we must be cautious in interpreting our results&#44; taking into account that the majority of our complications resulted in catheter replacement&#44; except for 4 patients with dialysate fluid leaks and those patients with complications at the catheter exit site&#46; This may reveal suboptimal salvage manoeuvres&#44; such as anti-infection treatment and catheter recovery using fluoroscopic guidance&#46;</p><p class="elsevierStylePara">One of the intrinsic properties of the omentum is that&#44; when it comes into contact with a foreign body&#44; it attempts to surround and isolate it&#46; Omental wrapping was a very common cause of catheter dysfunction in our study &#40;3&#46;7&#37;&#41;&#46; Some authors have suggested performing an omentectomy during catheter placement to avoid wrapping and the need for secondary interventions&#44;<span class="elsevierStyleSup">19</span> since 27&#37; of patients that do not undergo an omentectomy develop catheter obstruction&#46; We also observed a significant difference in catheter dysfunction and replacement when an omentectomy was performed&#46; In our study&#44; omentectomy had a protective effect against catheter dysfunction and replacement in both univariate and multivariate analyses&#44; <span class="elsevierStyleBold">probably due to the reduced rate of obstruction from omental wrapping</span>&#46;</p><p class="elsevierStylePara">The majority of studies assessing PD catheter placement place special emphasis on a previous history of abdominal surgery as a potential risk for PD complications&#46; Tiong et al<span class="elsevierStyleSup">5</span> analysed several factors related to catheter dysfunction and found that patients with a background of diabetes&#44; glomerulonephritis&#44; or previous abdominal surgery had a higher probability &#40;OR&#58; 3&#46;24&#59; 6&#46;52&#59; 3&#46;42&#44; respectively&#41; of early complications &#40;within 30 days after catheter placement&#41; in a population with a prevalence rate of 43&#46;8&#37; for previous surgery&#46; A longer duration of the surgical procedure was also associated with early complications&#46; Another study examining hernias as a potential complication of PD catheter placement<span class="elsevierStyleSup">17</span> found that patients with polycystic kidney disease had a 2&#46;5 times higher risk of complications&#44; and that female sex was a protective factor against the occurrence of hernias&#46; Although we observed several factors&#44; including age&#44; BMI&#44; BSA&#44; wound infection&#44; and post-incisional hernia that were associated with catheter dysfunction in the univariate analysis&#44; none were associated with a higher risk of catheter dysfunction and replacement in the logistic regression analysis&#46; Crabtree et al<span class="elsevierStyleSup">22</span> observed that abdominal scarring and previous history of peritonitis did not predict the severity of adherences and should not be used for deciding whether or not to use PD&#46; We did not observe any relationship with other aspects of surgery&#44; such as previous abdominal surgery or pre-existing medical conditions &#40;for example&#44; diabetes mellitus&#44; polycystic kidney disease&#41; that might affect selection criteria for entering our PD programme in the future&#46; Currently&#44; we do not assess patients based on previous abdominal surgery in order to use PD as a renal replacement therapy&#44; despite the low prevalence of previous abdominal surgery &#40;19&#46;6&#37;&#41; as compared to other studies&#46;<span class="elsevierStyleSup">5&#44;22</span> We should point out that in several of the previously mentioned studies the PD catheters were placed by several different surgical teams&#44; whereas in our study only one surgical team performed all procedures&#44; <span class="elsevierStyleBold">which partially standardises the results&#44; ensuring that the same criteria were used for performing an omentectomy or omentopexy and that the procedure was systematic</span>&#46;</p><p class="elsevierStylePara">Our study had several limitations&#44; primarily those related to the retrospective design of the study&#44; such as a biased sample selection&#44; no control group&#44; and difficulties in measuring and recording data for the different variables assessed&#46; Another issue in our results lies in the open approach used for catheter placement&#58; laparoscopic techniques are used more and more frequently<span class="elsevierStyleSup">7&#44;9&#44;10&#44;19&#44;20&#44;22</span>&#59; however&#44; several centres&#44; mainly from Asia&#44; still use open techniques with good results&#46;<span class="elsevierStyleSup">2-6&#44;17 </span>In particular&#44; we used an open approach for several reasons&#58; firstly&#44; we have limited use of laparoscopic techniques due to equipment and financial limitations&#44; and secondly&#44; both the open technique using a midline incision and the subjective criteria used for deciding to perform an omentectomy are easy to learn and reproduce by the residents at our hospital&#46; In addition&#44; our results are similar or better than the results from Asian studies involving open techniques in terms of mechanical complications<span class="elsevierStyleSup">4&#44;5&#44;8</span> and even better than results from laparoscopic techniques&#44;<span class="elsevierStyleSup">7&#44;9&#44;10</span> so we have continued to use an open surgical approach&#46;</p><p class="elsevierStylePara">In conclusion&#44; PD catheter placement using an open surgical approach with an infra-umbilical midline incision offers good results with few surgical complications after one year&#46; In our study&#44; we did not find significant risk factors for <span class="elsevierStyleBold">early</span> catheter replacement&#46; Omentectomy had a protective effect against catheter dysfunction and replacement&#46; A prospective&#44; randomised study evaluating omentectomy and PD catheter placement would confirm our conclusions&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11295&#95;16025&#95;29775&#95;en&#95;t111295&#46;jpg" class="elsevierStyleCrossRefs"><img src="11295_16025_29775_en_t111295.jpg" alt="Comparison of patients with peritoneal dialysis catheter dysfunction and those without"></img></a></p><p class="elsevierStylePara">Table 1&#46; Comparison of patients with peritoneal dialysis catheter dysfunction and those without</p><p class="elsevierStylePara"><a href="grande&#47;11295&#95;16025&#95;29776&#95;en&#95;t211295&#46;jpg" class="elsevierStyleCrossRefs"><img src="11295_16025_29776_en_t211295.jpg" alt="Predictive factors for peritoneal dialysis catheter dysfunction"></img></a></p><p class="elsevierStylePara">Table 2&#46; Predictive factors for peritoneal dialysis catheter dysfunction</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes</span>&#58; Las complicaciones asociadas con el cat&#233;ter en di&#225;lisis peritoneal causan disminuci&#243;n en su eficacia e interrupci&#243;n de &#233;sta&#44; conversi&#243;n a hemodi&#225;lisis&#44; hospitalizaciones y necesidad de cirug&#237;a para cambiar el cat&#233;ter&#46;&#160;<span class="elsevierStyleBold">Objetivos&#58;</span>&#160;Determinar factores de riesgo para la disfunci&#243;n&#160;<span class="elsevierStyleBold">temprana</span> del cat&#233;ter que hace necesario su cambio&#46;&#160;<span class="elsevierStyleBold">M&#233;todos&#58;</span>&#160;Se incluyeron 235 cat&#233;teres colocados con t&#233;cnica quir&#250;rgica abierta en l&#237;nea media infraumbilical&#46; Dentro de los posibles factores de riesgo se incluy&#243;&#58; edad&#44; g&#233;nero&#44; &#237;ndice de masa corporal&#44; &#225;rea de superficie corporal&#44; diabetes&#44; enfermedad poliqu&#237;stica renal&#44; cirug&#237;a previa&#44; tiempo quir&#250;rgico&#44; omentectom&#237;a&#44; omentopexia&#44; infecci&#243;n de la herida y hernia posincisional&#46;&#160;<span class="elsevierStyleBold">Resultados&#58;</span>&#160;El cambio del cat&#233;ter por disfuncionalidad ocurri&#243; en 47 pacientes &#40;20&#37;&#41;&#160;durante el primer a&#241;o&#46; La complicaci&#243;n m&#225;s frecuente fue&#58; migraci&#243;n del cat&#233;ter y peritonitis &#40;4&#44;3&#37; en ambos casos&#41;&#44; adem&#225;s de obstrucci&#243;n por el omento &#40;3&#44;7&#37;&#41;&#46; En el an&#225;lisis univariado&#44; los pacientes que presentaron disfunci&#243;n del cat&#233;ter&#47;cambio eran j&#243;venes con &#237;ndice de masa corporal y &#225;rea de superficie corporal bajos &#40;p &#60; 0&#44;05&#41;&#46; La infecci&#243;n de la herida y la hernia posincisional estaban asociados significativamente con el cambio de cat&#233;ter&#46; La omentectom&#237;a fue asociada a baja incidencia de disfunci&#243;n de cat&#233;ter&#47;cambio en el an&#225;lisis univariado y regresi&#243;n log&#237;stica &#40;raz&#243;n de momios&#58; 0&#44;275&#44; intervalo de confianza&#58; 95&#37;&#44; 0&#44;101-0&#44;751&#44; p &#60; 0&#44;012&#41;&#46; <span class="elsevierStyleBold">Conclusiones</span>&#58; Nuestra t&#233;cnica de inserci&#243;n de cat&#233;ter ofrece bajas&#160;tasas de complicaciones y buenos resultados el primer a&#241;o posquir&#250;rgico&#46; Adem&#225;s de la omentectom&#237;a&#44; en nuestro estudio no se encontr&#243; un factor de riesgo para cambio de cat&#233;ter en nuestra poblaci&#243;n&#46; La omentectom&#237;a tuvo un efecto protector en t&#233;rminos de cambio de cat&#233;ter&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58; </span>Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique&#44; conversion to haemodialysis&#44; hospitalisation&#44; and surgical interventions to replace the catheter&#46; <span class="elsevierStyleBold">Objectives&#58;</span> Determine risk factors for early catheter dysfunction that result in the need for replacement&#46; <span class="elsevierStyleBold">Methods&#58;</span> We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision&#46; Possible risk factors included the following&#58; age&#44; sex&#44; body mass index&#44; body surface area&#44; diabetes&#44; polycystic kidney disease&#44; previous surgery&#44; time of surgical procedure&#44; omentectomy&#44; omentopexy&#44; wound infection and postoperative incisional hernia&#46; <span class="elsevierStyleBold">Results&#58;</span> During the first year&#44; 47 patients &#40;20&#37;&#41; required a catheter replacement due to poor function&#46; The most common complications were catheter migration and peritonitis &#40;4&#46;3&#37; in both cases&#41;&#44; followed by obstruction from omental wrapping &#40;3&#46;7&#37;&#41;&#46; Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger&#44; with a lower body mass index and body surface area &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; There was a significant association of wound infection and post-operative incisional hernia with catheter replacement&#46; Omentectomy was associated with a low incidence rate of catheter dysfunction&#47;replacement in the univariate and logistical regression analyses &#40;odds ratio&#58; 0&#46;275&#59; 95&#37; confidence interval&#58; 0&#46;101-0&#46;751&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;012&#41;&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> Our catheter placement technique offers a low complication rate and good results in the first year after surgery&#46; Except for omentectomy&#44; we did not discover any risk factors for catheter replacement in our study population&#46; Omentectomy had a protective effect in terms of catheter replacement&#46;</p>"
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