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Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis

Journal of Nephrology volume 34, pages 1681–1696 (2021)Cite this article

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.

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Availability of data and material

The data are available upon request.

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Acknowledgements

We want to thank Dimitrios Kosmidis for his assistance in designing the tables and supplementary material of this manuscript.

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Affiliations

  1. Surgery Working Group, Society of Junior Doctors, Athens, Greece

    Stepan M. Esagian, Georgios A. Sideris, Ioannis A. Ziogas & Konstantinos P. Economopoulos

  2. Department of Radiology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA, USA

    Georgios A. Sideris

  3. Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA

    Muath Bishawi, Theodore N. Pappas & Konstantinos P. Economopoulos

  4. Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Ruediger W. Lehrich & John P. Middleton

  5. Department of Radiology, Duke University Medical Center, Durham, NC, USA

    Paul V. Suhocki

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  1. Stepan M. Esagian
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  2. Georgios A. Sideris
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Correspondence to Konstantinos P. Economopoulos.

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Esagian, S.M., Sideris, G.A., Bishawi, M. et al. Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol 34, 1681–1696 (2021). https://doi.org/10.1007/s40620-020-00896-w

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Keywords

  • Percutaneous catheter placement
  • Open surgical catheter placement
  • Laparoscopic catheter placement
  • Peritoneal dialysis catheter