A Comparison of Laparoscopic and Conventional Methods in Peritoneal Dialysis Catheter Placement in Patients with End-Stage Renal Disease: Single Center Experience

Abstract

OBJecTIVe: There is no consensus on superiority of peritoneal dialysis catheter placement methods to each other in the literature.Therefore, the aim of this study was to determine whether there were differences in complications between laparoscopic and percutaneous PD catheter placement methods performed in our hospital. mATerIAl and meTHODS: Forty patients with ESRD files were evaluated retrospectively. The patients were divided into two groups according to the placement method of PD catheters; namely, the Percutaneous Group (PG) and the Laparoscopic Group (LG). reSulTS: Dialysate leakage was seen only in one patient in PG (3.33%) while it was not seen in LG (p= 0.75). Malposition was detected only in five patients in PG (16.7%) and it was not seen in LG (p= 0.22). Catheter dysfunction occurred in four patients in PG (13.3%) while it was not seen in LG (p= 0.30). Hemoperitoneum did not develop in PG while it appeared in one patient (10%) in LG (p=0.25). Early peritonitis was detected in four patients in PG (13.3%) and in one (10%) patient in LG (p = 0.78). Exit site infection developed only in 10 patients (33.3%) from PG; however, it did not develop in LG (p=0.04). cONcluSION: Percutaneous PD catheter placement was preferred in our center, and fewer complications were observed with laparoscopic methods. We recommend laparoscopic PD catheter placement in patients with morbid obesity, prior abdominal surgery, herniation or malposition developing due to the percutaneous method and where percutaneous fixation is not possible.

Percutaneous Versus Surgical Insertion of Peritoneal Dialysis Catheters: A Systematic Review and Meta-Analysis

“…The initial search strategy yielded 1770 nonduplicate studies, of which 169 were selected for full-text review. Of the 169 studies, 24 16 - 39 met the inclusion criteria for our systematic review. Screening the reference lists of the included studies did not yield any additional studies.…”

“…17 There were 8 studies which employed a basic laparoscopic approach to catheter insertion, with 2 of those combining open surgical and laparoscopic insertion to create a "surgical insertion" comparison group (Table 1). 16,19,[23][24][25]28,38 Quantitative Meta-Analyses Infectious complications. Early infectious complication information was able to be extracted for exit-site infections and peritonitis.…”

“…For early peritonitis, 13 studies [18][19][20][21][22][23][24][25][26][27][28][29][30] reported results (Figure 2). The analysis of the pooled RR indicated a significant difference (RR = 0.52, 95% CI = 0.36-0.77) between the 2 techniques favoring percutaneous insertion, with no significant heterogeneity (I 2 = 3%, P = .41).…”

“…Overall complication rates were reported for exit-site infection, tunnel infection, and peritonitis. For overall exitsite infections, 16 studies [18][19][20][21][22][23][24]26,28,[31][32][33][34][35][36][37] reported it as an outcome (Figure 2), and upon analysis of the pooled RR, there was a significant difference favoring percutaneous insertion (RR = 0.61, 95% CI = 0.46-0.82). There was no significant heterogeneity (I 2 = 25%, P = .17).…”

“…For overall peritonitis, 21 studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39] reported it as an outcome (Figure 2), and upon analysis of the pooled RR, there was no significant difference (RR = 0.86, 95% CI = 0.68-1.09) between the 2 techniques. There was substantial heterogeneity (I 2 = 58%, P < .001).…”