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Omental Procedures During Peritoneal Dialysis Insertion: A Systematic Review and Meta-Analysis

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Abstract

Objectives

Peritoneal dialysis (PD) is an option for ultrafiltration for patients with end-stage renal disease. Once placed, PD catheters may malfunction often due to omental wrapping. Omental procedures such as omentectomy and omentopexy may reduce this risk. This investigation aims to perform a systematic review and meta-analysis of the literature on the role of omental procedures on PD catheter insertions.

Methods

Following protocol registration on PROSPERO (CRD42020218950), a systematic review was performed in accordance with the Cochrane Collaboration. A literature search was performed in February 2021 across Medline, EMBASE, Scopus, and Cochrane Library. Records with patients who underwent PD catheter insertion with and without omental manipulation were included. The records underwent screening, full-text review, and data extraction. Study qualities were assessed using RoBINS-I and RoB2. Effect estimates were extracted as risk ratios and corresponding 95% confidence intervals (CI) were pooled using inverse variance method with random-effect model.

Results

Of 510 records identified, 15 studies were included in the meta-analysis (1 RCT, 2 prospective, 12 retrospective). With omental procedures, there was decreased the likelihood of failure requiring removal of PD catheter (RR 0.47, 95% CI 0.38, 0.58) and PD catheter obstruction (RR 0.23, 95% CI 0.14, 0.39); there was no difference in likelihood of catheter malposition or migration (RR 0.87, 95% CI 0.23, 3.29) or peritonitis (RR 0.74, 95% CI 0.40, 1.35).

Conclusion

Based on the current low to moderate quality of evidence, omental manipulation at the time of PD catheter insertion confers benefits of decreased obstruction and failure requiring removal.

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Abbreviations

PD:

Peritoneal Dialysis

ESRD:

End-stage renal disease

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Author notes

  1. Jin K. Kim and Marisol Lolas these two authors contributed equally to the manuscript.

Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada

    Jin K. Kim, Martin A. Koyle, Armando J. Lorenzo & Michael E. Chua

  2. Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Jin K. Kim, Marisol Lolas, Daniel T. Keefe, Mandy Rickard, Priyank Yadav, Martin A. Koyle, Armando J. Lorenzo & Michael E. Chua

  3. Division of Urology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA

    Jessica M. Ming

  4. Institute of Urology, St. Luke’s Medical Center, Quezon City, Philippines

    Michael E. Chua

  5. Division of General Surgery, Department of Surgery, Nelson Mandela Children’s Hospital, Johannesburg, South Africa

    Karen Milford

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  1. Jin K. Kim
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Appendix A

Appendix A

Embase search strategy

1

exp peritoneal dialysis/

2

CAPD.mp. or exp continuous ambulatory peritoneal dialysis/

3

exp omentum/or oment*.mp

4

exp omentectomy/

5

tenckhoff.mp

6

exp peritoneal dialysis catheter/or exp catheter/or exp dialysis catheter/

7

1 or 2

8

3 or 4

9

5 or 6

10

7 and 8 and 9

Medline search strategy

1

exp Peritoneal Dialysis/

2

CAPD.mp. or exp Peritoneal Dialysis, Continuous Ambulatory/

3

exp Omentum/or oment*.mp

4

omentectomy.mp

5

Tenckhoff.mp

6

exp Catheters/

7

1 or 2

8

3 or 4

9

5 or 6

10

7 and 8 and 9

Scopus search strategy

( TITLE-ABS-KEY ( peritoneal AND dialysis OR pd OR capd OR continuous AND ambulatory AND peritoneal AND dialysis) AND TITLE-ABS-KEY ( oment* OR omentectomy OR omentum) AND TITLE-ABS-KEY ( tenckhoff OR catheter*)).

Cochrane search strategy

Peritoneal Dialysis in Title Abstract Keyword OR PD in Title Abstract Keyword OR Continuous Ambulatory Peritoneal Dialysis in Title Abstract Keyword OR CAPD in Title Abstract Keyword AND Catheter* in Title Abstract Keyword AND (oment*) in Title Abstract Keyword—(Word variations have been searched).

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Kim, J.K., Lolas, M., Keefe, D.T. et al. Omental Procedures During Peritoneal Dialysis Insertion: A Systematic Review and Meta-Analysis. World J Surg 46, 1183–1195 (2022). https://doi.org/10.1007/s00268-021-06413-9

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  • DOI: https://doi.org/10.1007/s00268-021-06413-9

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