International Journal of Nephrology study (timely PD study) has been set up to address the inﬂuence of diﬀerent break in periods [42]. 3.7. Hernia Repairs. Utmost importance should be given to the consent, where the patient should be counselled for hernia repair found at the time of the operation. Grac´ıa- Uren˜a et al. in their article yet stress the importance of identifying and repairing of hernias prior to commencing PD [43]. The hernioplasty should be performed using prosthetic material as a tension-free repair, hence, to reduce the risk of recurrence in peritoneal dialysis patient [43–45]. This may lead to a small draw back being a delay in initial catheter use for peritoneal dialysis and patients should be warned about interim haemodialysis [9, 10], though literature supports successful immediate restart of PD [45]. 3.8. Number of Cuﬀs. Controversy lies with either using a catheter with a single or two cuﬀs. A single-cuﬀed catheter logically avoids a second foreign body being placed in the less-vascularised subcutaneous tissue, thereby reducing the risk of cuﬀ infections or colonisation near the exit-site [9]. Eklund et al., published in a small RCT (30 per arm) that there to be no signiﬁcant diﬀerence between catheters with single or double cuﬀs with respect to catheter survival, episodes of peritonitis, and exit-site infections [46]. Though, some published lines of literature prefer two-cuﬀed catheters as they reduce risk of peritonitis in the long run [9]. Nessim et al., reported double cuﬀ were associated with reduced peritonitis rates between 1996 and 2000, though after 2000 this risk disappeared and was probably due to inﬂuence of prophylactic measures or increase in experience on the risk of infection over time [47]. The Cochrane Review did not ﬁnd any advantage for straight versus coiled catheters, single or double cuﬀ, and median or lateral incision [21] and the ISPD guidelines recommend no diﬀerence (ISPD: 5.2) [14]. 3.9. Catheter-Embedding Procedures. These procedures were initially described by Moncrief et al., [48], where the procedure entails the external limb of the dialysis catheter is embedded subcutaneously at the time of implantation. After about 3–5 weeks interval, exteriorization is carried out under local anaesthesia in the day case setting. Brown et al., recommend insertion 6 weeks to 5 months ahead of the need for PD to maximize catheter survival. The authors looked at three groups of patients starting PD 11–47 days, 48–133 days, and more than 133 days after placement of embedded catheters. The time to catheter loss was shortest in group 1 and longest in group 2 and suggested that mechanical complications and catheter loss are associated with the length of time a catheter is embedded [49]. The concept speculated reduced catheter-related infection due to ﬁrm tissue ingrowth of the cuﬀ and the absence of a bioﬁlm. With time and use of antibiotic prophylaxis these procedures had initially lost their popularity. But in reality it may be a useful strategy to lock a patient into peritoneal so as to avoid crash haemodialysis with a tunnelled catheter if sudden decline in renal function were to occur. The technique of embedding 3 allows eﬃcient surgical scheduling of catheter placement as a planned procedure which can lead to a signiﬁcant longer catheter life [50] and fewer earlier complications [51]. 3.10. Rectus Sheath Tunnelling. This leads to creation of a long musculofascial tunnel in a craniocaudal direction, thus maintaining pelvic orientation of the catheter tip [52– 55]. This manoeuvre leads to reduced risk of pericannular leaks and hernias [10]. A detailed step-by-step technique for rectus sheath tunnelling has been described by Crabtree [10]. To facilitate a further reduction of leaks during transrectus placement, a ﬁxation suture around the catheter at the anterior rectus sheath may be placed, with the cuﬀ being secured at this fascial layer [56–58]. Attaluri et al., data clearly showed a signiﬁcant improvement in PD catheter function using omentopexy and rectus sheath tunnelling [58]. 3.11. Laparoscopic Fixation. Laparoscopic ﬁxation to prevent catheter tip migration may be carried out where the catheter tip is ﬁxed to the lower abdomen or pelvis [59, 60]. The drawback here is an increased risk of obstructing adhesions, potential for internal hernias and suture knot, a nidus for persistent infection; proper rectus sheath tunnelling and placement of the deep cuﬀ are the key to reducing catheter tip migration [10]. 3.12. Omentopexy. Omentopexy is usually carried out when partial or complete catheter obstruction/displacement is pro- duced due to omental entrapment. The procedure involves a laparoscopic omental tack up, which is performed high in the abdomen at the Palmer point [61] or to the falciform ligament [62]. This procedure is not limited to rescuing catheters from omental entrapment and does play a valuable role in selective prophylactic omentopexy as an adjunctive procedure to catheter implantation as assessed by an intra- operative catheter trial [6] and especially when the omentum extends to the pelvis in a juxtaposition of the peritoneal catheter tip [63]. 3.13. Omentectomy. Omentectomy is usually avoided as an omentopexy is a much quicker and cost-eﬀective procedure with an equivalent outcome [10, 64]. Persistent dysfunction problems due to omental wraps and failed omentopexy warrant an omentectomy though rare. 3.14. The Modiﬁed “Y”-Tec System. This system permits the procedure to be carried out with either a single 5 mm lap- port or a 2.2 mm peritoneoscope, thus leading to reduced incisions, leaks, and hernias. In addition, in particular with the laparoscope, an adequate and thorough diagnostic look can be carried out in particular for redo/exchange of PD catheters. Additional ports can be inserted to carry out procedure like adhesiolysis, omentopexy, and peritoneal biopsies [65]. 3.15. Resection of Epiploic Appendages. Epiploic appendages are an infrequent cause of catheter dysfunction and can be identiﬁed during the intraoperative catheter trial irrigation