Hindawi Publishing Corporation International Journal of Nephrology Volume 2012, Article ID 251584, 7 pages doi:10.1155/2012/251584 Review Article A Brief Recap of Tips and Surgical Manoeuvres to Enhance Optimal Outcome of Surgically Placed Peritoneal Dialysis Catheters Jodie H. Frost and Atul Bagul Transplant Division, III Department, University of Leicester, Leicester LE1 7RH, UK Correspondence should be addressed to Atul Bagul, atulbagul@yahoo.com Received 12 February 2012; Revised 11 June 2012; Accepted 21 June 2012 Academic Editor: Anil K. Agarwal Copyright © 2012 J. H. Frost and A. Bagul. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Peritoneal dialysis (PD) is an eﬀective option of renal replacement therapy for ESRF, oﬀering advantages over haemodialysis. Peritoneal dialysis catheter (PDC) placement is thought to be the key to successful PD and the economic advantages are lost if a patient switches to HD in the 1st year. This paper is a brief document elaborating a recap of published literature, looking at various surgical tips and manoeuvres to enhance optimal outcome of PDC placement. Methods. A search strategy assessing for access team, preoperative antibiotic prophylaxis, type of catheter, catheter exit site, intraoperative catheter trial, optimal time to commence PD, hernia repairs, number of cuﬀs, catheter-embedding procedures, rectus sheath tunnelling, laparoscopic ﬁxing, omentopexy, omentectomy, the “Y”-Tec system, resection of epiploic appendages, adhesiolysis, a trained surgeon, and perioperative catheter care protocol was used looking at various databases. Findings. The complications of catheterrelated dysfunction can be reduced with advanced planning of access placement, immaculate surgery, and attention to catheter insertion techniques. Conclusion. The success of a peritoneal dialysis programme depends upon functional and durable long term access to the peritoneal cavity; this depends on placement techniques and competent surgeons and psychosocial support to the patient. The various technical tips and manoeuvres elaborated here should be considered options carried out to improve outcome and reduce catheter dysfunction. 1. Introduction Peritoneal dialysis (PD) is an eﬀective option of renal replace- ment therapy for end-stage renal failure, oﬀering advantages such as it being a modality undertaken at home, encourages self-autonomy, and optimises quality of life [1, 2]. It is well established that access-related morbidity and mortality are signiﬁcantly lower for PD than for Haemodialysis (HD) [3]. Its other advantages are improved survival beneﬁt during the ﬁrst 1 to 2 years due to better preservation of residual function and improved blood volume and blood pressure control [4, 5]. Peritoneal dialysis is less expensive than HD, a cost diﬀerence of $19,000/person/year in the USA (PD8– 28) and £12,000/person/year in the UK (NHSBT-website: http://www.organdonation.nhs.uk/). The success of PD depends upon the presence of a functional and durable long term access to the peritoneal cavity, which depends upon placement technique rather than on catheter design [6]. Thus, catheter placement is thought to be the key of successful PD and the economic advantages are lost if a patient switches to HD in the 1st year [7]. Pri- mary nonfunction rate for PDC in literature is quoted at 10% [8]. The potential complication for PDC placement includes mechanical ﬂow dysfunction usually associated with malposition, leak, exit-site infection/peritoneal infection, intra-abdominal injuries, and catheter blockages [9]. These complications can be reduced with advanced planning of access placement, immaculate surgery, attention to catheter insertion techniques, and psychosocial support to the patient [10, 11]. Catheter-related problems like recurrent leaks and hernias, leading to a delay for PD and if not further surgical procedures increase pyscho-social problems in this cohort