Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis
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REVIEW
Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta‑analysis Stepan M. Esagian1 · Georgios A. Sideris1,2 · Muath Bishawi3 · Ioannis A. Ziogas1 · Ruediger W. Lehrich4 · John P. Middleton4 · Paul V. Suhocki5 · Theodore N. Pappas3 · Konstantinos P. Economopoulos1,3 Received: 29 July 2020 / Accepted: 28 October 2020 © Italian Society of Nephrology 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. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00896-w) contains supplementary material, which is available to authorized users. * Konstantinos P. Economopoulos [email protected] 1
Surgery Working Group, Society of Junior Doctors, Athens, Greece
2
Department of Radiology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA, USA
3
Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
4
Division of Nephrology, Department of Medicine, D
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