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

Journal Article (Journal Article;Review;Systematic Review)

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.

Full Text

Duke Authors

Cited Authors

  • Esagian, SM; Sideris, GA; Bishawi, M; Ziogas, IA; Lehrich, RW; Middleton, JP; Suhocki, PV; Pappas, TN; Economopoulos, KP

Published Date

  • October 2021

Published In

Volume / Issue

  • 34 / 5

Start / End Page

  • 1681 - 1696

PubMed ID

  • 33197001

Electronic International Standard Serial Number (EISSN)

  • 1724-6059

Digital Object Identifier (DOI)

  • 10.1007/s40620-020-00896-w


  • eng

Conference Location

  • Italy