Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis
Author Department
Radiology
Document Type
Article, Peer-reviewed
Publication Date
11-2020
Abstract
Background: No consensus currently exists regarding the optimal approach for peritoneal dialysis catheter placement. We aimed to compare the outcomes of percutaneous and surgical peritoneal dialysis catheter placement.
Methods: A systematic review of the literature was performed using the MEDLINE, Cochrane Library, and Scopus databases (end-of-search date: August 29th, 2020). We included studies comparing percutaneous (blind, under fluoroscopic/ultrasound guidance, and "half-perc") and surgical peritoneal dialysis catheter placement (open and laparoscopic) in terms of their infectious complications (peritonitis, tunnel/exit-site infections), mechanical complications (leakage, inflow/outflow obstruction, migration, hemorrhage, hernia, bowel perforation) and long-term outcomes (malfunction, removal, replacement, surgery required, and mortality).
Results: Thirty-four studies were identified, including thirty-two observational studies (twenty-six retrospective and six prospective) and two randomized controlled trials. Percutaneous placement was associated with significantly lower rates of tunnel/exit-site infection [relative risk (RR) 0.72, 95% confidence interval (CI) 0.56-0.91], catheter migration (RR 0.68, 95% CI 0.49, 0.95), and catheter removal (RR 0.73, 95% CI 0.60-0.88). The 2-week and 4-week rates of early tunnel/exit-site infection were also lower in the percutaneous group (RR 0.45, 95% CI 0.22-0.93 and RR 0.41, 95% CI 0.27-0.63, respectively). No statistically significant difference was observed regarding other outcomes, including catheter survival and mechanical complications.
Conclusion: Overall, the quality of published literature on the field of peritoneal dialysis catheter placement is poor, with a small percentage of studies being randomized clinical trials. Percutaneous peritoneal dialysis catheter placement is a safe procedure and may result in fewer complications, such as tunnel/exit-site infections, and catheter migration, compared to surgical placement.
Protocol registration: PROSPERO CRD42020154951.
Keywords: Laparoscopic catheter placement; Open surgical catheter placement; Percutaneous catheter placement; Peritoneal dialysis catheter.
Recommended Citation
Esagian SM, Sideris GA, Bishawi M, Ziogas IA, Lehrich RW, Middleton JP, Suhocki PV, Pappas TN, Economopoulos KP. Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol. 2020 Nov 16. doi: 10.1007/s40620-020-00896-w. Epub ahead of print.
PMID
33197001