Surgical Management of Refractory Exit-Site/Tunnel Infection of Tenckhoff Catheter: Technical Innovations of Partial Replantation

Objective: Catheter-related infection has been the major cause of catheter removal for peritoneal dialysis (PD) patients. A salvage technique-partial replantation of the infected catheter-was developed in our hospital to rescue catheters with refractory exit-site or tunnel infection. Patients: We performed 26 partial replantations of Tenckhoff catheters for 23 patients with refractory exit-site or tunnel infection and 2 patients with near-cuff perforation of the catheter. Their problems were all resolved successfully without interruption of PD. Interventions: We removed the infected portion of the catheter and preserved the still- functioning internal conduit, connecting it to a divided new catheter. All of the patients resumed PD immediately after the advancement of the new catheter through a new subcutaneous tunnel and exit site on the opposite side. Results: No technical complications such as disconnection of the catheter or leakage of dialysate were noted. Repeated partial replantation of the catheter was done for 1 patient with a new refractory exit-site infection . Tunnel infection was not an absolute contraindication for this procedure. About one third (34.6%) of our patients had preoperative tunnel infection. Conclusion: Partial replantation of a Tenckhoff catheter is a simple and effective procedure for patients with refractory exit- site/ tunnel infection and patients with near-cuff perforation of the catheter. Repeated partial replantation is also feasible for repeat exit- site infections