From Wobble to Wisdom: Sharma-Devana PGI Modification of Hanging Loop Technique for Laparoscopic Peritoneal Dialysis Catheter Insertion

Background Continuous ambulatory peritoneal dialysis (CAPD) is widely used for ESKD, but catheter migration remains a major cause of malfunction. The Santosh-PGI Hanging Loop Technique, introduced in 2015, minimized the need for intracorporeal suturing and reduced migration. However, this technique was marred by difficult clip placement on the anterior abdominal wall and consequent catheter migration. We describe a novel modification to further enhance catheter stability. Materials and Methods Under general anesthesia, pneumoperitoneum was created via the Veress technique. A 5 mm camera and two 12 mm ports were employed, with the catheter placement port tunnelled obliquely for added anchorage. Initially, a modified epidural needle with a polypropylene loop was used; subsequently, the Carter-Thomason® Port Site needle facilitated easier passage of 2-0 polypropylene sutures around the catheter. Two snug subcutaneous loops were created to secure the catheter to the anterior abdominal wall while ensuring cuff positioning and catheter patency. Results Eight patients underwent the procedure with an average operative time of 37.5 minutes and negligible blood loss. All catheters remained functional without migration, malfunction, or omental entrapment during follow-up. Two catheters were removed for peritonitis at 8 and 18 months, unrelated to migration. The Carter-Thomason needle simplified fixation and reduced operative time compared to the epidural needle technique. Conclusion The Sharma-Devana PGI modification of the Hanging Loop Technique provides a reliable, minimally invasive solution to prevent CAPD catheter migration. It is reproducible, adaptable with locally available instruments, and may reduce the need for reoperations in patients with multiple comorbidities.