Renal Replacement Therapy (Sep 2019)

Outcomes after peritoneal dialysis catheter placement by laparoscopic surgery versus open surgery: systematic review and meta-analysis

  • Tsutomu Sakurada,
  • Atsushi Ueda,
  • Daisuke Komukai,
  • Kiyotaka Uchiyama,
  • Yasushi Tsujimoto,
  • Hidemichi Yuasa,
  • Munekazu Ryuzaki,
  • Yasuhiko Ito,
  • Masashi Tomo,
  • Hidetomo Nakamoto

DOI
https://doi.org/10.1186/s41100-019-0232-9
Journal volume & issue
Vol. 5, no. 1
pp. 1 – 13

Abstract

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Abstract Success in peritoneal dialysis (PD) requires a well-functioning catheter, and catheter placement at PD initiation is extremely important for long-term PD. Although several randomized, controlled trials (RCTs) have compared open surgery with laparoscopic surgery, there is controversy regarding which surgical approach is desirable. The present systematic review and meta-analysis was performed to clarify which surgical approach is superior. A systematic literature search for RCTs was performed using the Cochrane Central Register of Controlled Trials and the MEDLINE database, and a meta-analysis was performed using Review Manager Version 5.3.5 (Cochrane Collaboration, Oxford, UK). Catheter survival was the primary outcome, and leakage, hernia, requirement for reoperation, catheter-related infection, postoperative pain, hospitalization period associated with catheter placement, and catheter migration were the secondary outcomes. After screening 913 references, seven RCTs were analyzed. Laparoscopic surgery was found to have no favorable effect on catheter survival (5 trials, 424 patients; risk ratio [RR] 1.02; 95% confidence interval [CI] 0.92–1.13; p = 0.68; low-quality evidence]. The incidence of catheter migration was significantly lower with laparoscopic surgery (6 trials, 526 patients; RR 0.42; 95% CI 0.18–0.96; p = 0.04; moderate-quality evidence). However, the significance decreased on limiting the analysis to RCTs involving laparoscopic surgery without secured suture of the PD catheter (4 trials, 431 patients; RR 0.58; 95% CI 0.27–1.25; p = 0.17; moderate-quality evidence). Other outcomes were similar between open surgery and laparoscopic surgery. The present findings indicate that laparoscopic surgery has a limited advantage over open surgery with respect to PD patients’ outcomes.

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