Technique of intraperitoneal chemotherapy

1. Early postoperative technique
   After cytoreductive surgery a Tenckhoff catheter is placed through abdominal wall in the approximate area at the highest risk of recurrence. Closed suctions drains are placed in dependent areas in the pelvis and below each diaphragm. The abdomen is closed and then thoroughly lavaged through the Tenckhoff catheter to clear any blood clots or tissue debris. Intraperitoneal chemotherapy administered postoperatively then is drained through the closed suction drains.
   Therapy usually occurs in the first three to five postoperative days.
2. intraoperative closed technique
   After cytoreduction, inflow and outflow catheters are placed - normally one catheter is placed for inflow of drugs and four as out-flow drainage. After temporary closure of the abdomen, perfusate with chemotherapy is infused. The abdominal wall is manually agitated during the perfusion period in an attempt to promote uniform distribution. After end of perfusion abdomen is re-opened and the perfusate evacuated.
3. Open abdomen technique (Coliseum)
   Catheters are placed in the same way as described above. A silastic sheet is sutured over a Thompson retractor and to the patient´s skin over the abdominal incision. This suspends that abdominal wall creation a ´Coliseum´ container for instillation of peritoneal perfusate. An incision is made in the middle of the sheet to allow manual manipulation of the intra-abdominal contents to prevent stasis of the perfusate.
   
   
   
4. peritoneal cavity expander technique
   Peritoneal cavity expander is an acrylic cylinder containing inflow and outflow catheters that are secured over the wound. After cytoreduction is performed in a standard fashion this expander is placed into peritoneal cavity in such a way that small intestine can float freely and manual manipulation is possible. After perfusion is finished the expander will be removed.

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