Low-site versus traditional peritoneal dialysis catheterization

Abstract

Background: The objective of this study was to compare the complications of low-site peritoneal dialysis (PD) catheter placement and traditional open surgery in peritoneal dialysis catheter insertion. Methods: The following databases were searched from inception to September 6, 2019: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang. Eligible studies comparing low-site PD catheter placement and traditional open surgery in peritoneal dialysis catheter insertion were included. The data were analyzed using Review Manager Version 5.3. Results: Seven studies were included in the meta-analysis. A total of 504 patients were included in the low-site PD catheter placement group, and 325 patients were included in the traditional open surgery group. Compared with traditional open surgery, low-site PD catheter placement had a lower incidence rate of catheter displacement (odds ratios [OR] 0.11, 95% CI 0.05–0.22, P < .01) and noncatheter displacement dysfunction (OR 0.11, 95% CI 0.04–0.31, P < .01). However, there was no difference between the 2 catheter insertion methods concerning bleeding (OR 0.53, 95% CI 0.23–1.22, P = .13), PD fluid leakage (OR 0.40, 95% CI 0.15–1.10, P = .07), hypogastralgia (OR 0.95, 95% CI 0.32–2.80, P = .93), peritonitis (OR 0.70, 95% CI 0.32–1.54, P = .38), or exit-site and tunnel infections (OR 0.39, 95% CI 0.14–1.03, P = .06). Conclusion: Low-site PD catheter placement reduced the risk of catheter displacement and noncatheter displacement dysfunction and did not increase the risk of bleeding, PD fluid leakage, hypogastralgia, peritonitis, or exit site and tunnel infections. Additional large multicenter randomized controlled trials are needed to confirm these conclusions.

Laparoscopy-assisted peritoneal dialysis catheter placement using a modified minimally invasive approach: A retrospective observational study

“…Moreover, in the same study, it was reported that short-segment peritoneal catheter placement in the pelvis did not cause bowel movements, and omental wrapping complications were observed less frequently. [ 7 ] Our results are consistent with these findings.…”

“…Laparoscopic lysis of the adhesions is recommended to reduce catheter dysfunction. [ 7 ] In adhesions that do not minimize peritoneal capacity and disrupt its integrity, adhesions can be released by passing a 5 mm ultrasonic shears through the pull-apart sheath/dilator without the need for an additional trocar, which will prevent the insertion of a suitable PD catheter in the Douglas pouch in the pelvic region. [ 8 ] The larger the number of compartments and the greater the area occupied, the greater is the surgical intervention required.…”

“…Recent studies and evidence on low-site peritoneal dialysis catheter placement have encouraged us to modify our approach. [7] We aimed to enhance the success rate by implementing straightforward modifications that capitalize on the advantages of the standard laparoscopic approach, ultimately reducing the mechanical complications.…”

“…Recent studies and evidence on low-site peritoneal dialysis catheter placement have encouraged us to modify our approach. [ 7 ]…”

How to Prevent Peritoneal Dialysis Catheter Tip Migration: A Japanese Perspective

“…Some studies have reported using the "very low site approach" to reduce the risk of catheter migration. With this approach, the catheter is inserted a few centimeters above the suprapubic margin, reducing the risk of catheter migration [13][14][15]. This approach requires an adaptative catheter cut extending from the insertion point at the peritoneum to the pelvic floor.…”