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Meta-Analysis
. 2013;8(2):e56351.
doi: 10.1371/journal.pone.0056351. Epub 2013 Feb 15.

Laparoscopic versus open peritoneal dialysis catheter insertion: a meta-analysis

Sander M Hagen  1 , Jeffrey A Lafranca, Ewout W Steyerberg, Jan N M IJzermans, Frank J M F Dor
Affiliations
Meta-Analysis

Laparoscopic versus open peritoneal dialysis catheter insertion: a meta-analysis

Sander M Hagen et al. PLoS One. 2013.

Abstract

Background: Peritoneal dialysis is an effective treatment for end-stage renal disease. Key to successful peritoneal dialysis is a well-functioning catheter. The different insertion techniques may be of great importance. Mostly, the standard operative approach is the open technique; however, laparoscopic insertion is increasingly popular. Catheter malfunction is reported up to 35% for the open technique and up to 13% for the laparoscopic technique. However, evidence is lacking to definitely conclude that the laparoscopic approach is to be preferred. This review and meta-analysis was carried out to investigate if one of the techniques is superior to the other.

Methods: Comprehensive searches were conducted in MEDLINE, Embase and CENTRAL (the Cochrane Library 2012, issue 10). Reference lists were searched manually. The methodology was in accordance with the Cochrane Handbook for interventional systematic reviews, and written based on the PRISMA-statement.

Results: Three randomized controlled trials and eight cohort studies were identified. Nine postoperative outcome measures were meta-analyzed; of these, seven were not different between operation techniques. Based on the meta-analysis, the proportion of migrating catheters was lower (odds ratio (OR) 0.21, confidence interval (CI) 0.07 to 0.63; P = 0.006), and the one-year catheter survival was higher in the laparoscopic group (OR 3.93, CI 1.80 to 8.57; P = 0.0006).

Conclusions: Based on these results there is some evidence in favour of the laparoscopic insertion technique for having a higher one-year catheter survival and less migration, which would be clinically relevant.

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Conflict of interest statement

Competing Interests: The authors declare no competing interests.

Figures

Figure 1
Figure 1. PRISMA flow diagram of the systematic literature search.
Figure 2
Figure 2. Risk of bias summary graph of the included studies.
The green symbol indicates that there is possibly a low level of bias, red symbolizes a possible high level of bias and a yellow symbol is presented if the risk of bias is unclear.
Figure 3
Figure 3. Forest plot.
Odds ratios of the incidence of peritonitis and exit-site/tunnel infection, evaluating the statistical difference between laparoscopic and open PD catheter insertion. CI: confidence interval.
Figure 4
Figure 4. Forest plot.
Odds ratios of the incidence of migration, leakage and obstruction, evaluating the statistical difference between laparoscopic and open PD catheter insertion. CI: confidence interval.
Figure 5
Figure 5. Forest plot.
Odds ratio of the incidence of intervention/revision and catheter removal, evaluating the statistical difference between laparoscopic and open PD catheter insertion. CI: confidence interval.
Figure 6
Figure 6. Forest plot.
Odds ratios of the catheter survival, at one year and two years after insertion, evaluating the statistical difference between laparoscopic and open PD catheter insertion. CI: confidence interval.
Figure 7
Figure 7. Summery of findings table generated by the GRADE tool.
See this image and copyright information in PMC

References

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