Long‐Term Complication Rates and Survival of Peritoneal Dialysis Catheters: The Role of Percutaneous Versus Surgical Placement

Abstract

Considerable controversy currently exists in the literature concerning the mode of catheter placement and its impact on the technical success of peritoneal dialysis (PD). We decided to compare the impact of the surgical versus the percutaneous insertion technique on peritoneal dialysis catheter (PDCs) complications and survival. Our study population comprised 152 patients in whom 170 PDCs were inserted between January 1990 and December 2007 at the main PD unit on the island of Crete. Eighty four catheters were surgically placed (S group) and 86 were placed percutaneously by nephrologists (N group). The total experience accumulated was 4997 patient-months. The overall complications did not differ between the two groups. Only early leakage was more frequent in N group than S group (10.3 versus 1.9 episodes per 1000 patient-months; p < 0.001). However, it was easily treated and did not constitute a cause of early catheter removal. Catheter survival was 91.1%, 80.7%, and 73.2%, in the S group versus 89.5%, 83.7%, and 83.7% for the N group at 1, 2, and 3 years, respectively (p = 0.2). Catheter survival has significantly increased over the last decade. Factors positively affecting PDC survival appeared to be the use of mupirocin for exit site care and the utilization of the coiled type of catheter, practices implemented mainly after 1999. Peritonitis-free survival and patient survival were not associated with the mode of placement, while in Cox regression analysis, were longer in patients treated with automated PD. The placement mode did not affect PD outcomes. Percutaneous implantation proved a safe, simple, low cost, immediately available method for PDC placement and helped to expand our PD program.

Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum

“…Selection bias, previous laparotomy, operator expertise, catheter type (coiled vs straight) and, in the case of peritonitis, other patient-related factors are all potential confounders that may have affected outcomes in these retrospective studies. Dialysate leakage was seen more frequently in the percutaneous insertion groups in some studies (8)(9)(10)15,22); other studies showed no difference between the two groups (6,7,11,13). The higher incidence of leakage associated with percutaneous placement may be partly attributed to a shorter break-in period (time from insertion to use of catheter) in the percutaneous insertion groups (8,9,15,22).…”

“…Excluding those two outlying cohorts in whom 1-year catheter survival was only 33-36%, the average survival of catheters inserted using the percutaneous technique in the literature was 80% at 12 months following insertion. Percutaneously inserted catheters also appear to fare well in terms of overall complication rates with some studies showing a reduced peritonitis rate (6,8,15) and other studies showing no significant differences in peritonitis rates between the two insertion groups (7,11). Similarly, no difference in incidence of unresolved drainage failure was seen between the two groups in most studies that compared the 2 techniques (7-9,11,15).…”

“…To date, there are at least 20 other published reports on bedside percutaneous PDC insertion in the English literature, mostly retrospective cohort studies (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)22,(36)(37)(38)(39)(40)(41)(42)(43). Although some studies compared percutaneous to surgical insertions, only the study by Perakis et al matched patients for previous laparotomy showing no significant difference between the two groups, but there was a trend towards more laparotomy incisions in the surgical insertion cohort (15). Most of the studies that reported results of survival analysis showed favorable survival with the percutaneous technique except the study by Mellotte et al where outcomes were significantly affected by severity of illness of those selected for percutaneous insertion (22).…”

“…Surgical insertion via minimal laparotomy remains the most common technique of PDC placement (2)(3)(4), and in the United States, laparoscopic insertions account for at least a quarter of total PD access procedures (5). However, previous studies have shown encouraging outcomes of percutaneous insertion of PDCs, demonstrating favorable catheter survival and a good safety profile (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). There are few specific indications to recommend one technique over the other.…”

Peritoneal Dialysis for Acute Kidney Injury

“…Perakis et al reported 170 PD catheter insertions (86 percutaneous) where a higher incidence of leak occurred in the percutaneous group (10% vs 2%). However, infectious complications were higher in the surgical group (25). A trial from Iran randomized 64 patients to surgical or percutaneous insertion and found a higher incidence of outflow failure and hemoperitoneum in the surgical group.…”