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Observational Study
. 2020 Jul 20;21(1):288.
doi: 10.1186/s12882-020-01936-0.

An analysis of the "Half-Perc" versus open surgical placement method for a peritoneal dialysis catheter: a non-inferiority cohort study

Difei Zhang  1   2 , Yu Peng  1   2 , Tingting Zheng  1   2 , Hui Liu  1   2 , Jianfeng Wu  1   2 , Zewen Li  1   2 , Jingxu Su  1   2 , Yuan Xu  1   2 , Xiaoxuan Hu  1   2 , Guowei Chen  1   2 , Haijing Hou  1   2 , La Zhang  1   2 , Liwen Wu  1   2 , Xusheng Liu  1   2 , Fuhua Lu  3   4
Affiliations
Observational Study

An analysis of the "Half-Perc" versus open surgical placement method for a peritoneal dialysis catheter: a non-inferiority cohort study

Difei Zhang et al. BMC Nephrol. .

Abstract

Background: Most end-stage renal disease (ESRD) patients undergo open surgical techniques for peritoneal dialysis (PD) catheter placement. An alternative method to PD catheter implantation is the half-percutaneous ("Half-Perc") technique based on a modified trocar that is performed by a nephrologist. The single-center, retrospective, observational, cohort study presented here aimed to compare the effects of the "Half-Perc" technique with the traditional open surgery on peritoneal catheter insertion.

Methods: From January 2015 to January 2018, 240 ESRD patients who received initial PD catheter placement were divided into two groups based on the "Half-Perc" technique or open surgery. All patients were followed up for 365 days or until loss of initial PD catheter or death. Prism 5 software was used to analyze baseline characteristics, operation-related parameters, mechanical complications and clinical outcomes.

Results: The "Half-Perc" technique showed shorter operation time, shorter incision length, lower postoperative pain scores and quick initiation of the PD program compared to the open surgery. After the 365-day follow-up, the "Half-Perc" group showed a higher rate of catheter dysfunction (4% versus 0.9%) that was corrected by conservative treatment in most patients and a lower rate of peritonitis (4% versus 9.6%) but mechanical complications and clinical outcomes did not differ between the two groups. There was also no significant difference based on overall patient mortality or catheter removal. One-year initial catheter survival and true catheter survival were not statistically different between the groups.

Conclusion: The "Half-Perc" placement of the PD catheter using a modified metal trocar appears to be a non-inferior alternative method and carries minimal invasiveness and risk compared to open surgical placement.

Keywords: Catheter placement; Clinical outcome; Half-Perc; Open surgery; Peritoneal dialysis.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Schematic of the study flow chart
Fig. 2
Fig. 2
Components of the trocar device. A. The structure of a modified trocar: a Core-needle. b Metal trocar, including 2 independent parts. c Hoop. B. Configuration of the modified trocar
Fig. 3
Fig. 3
Kaplan–Meier plot for catheter survival based on PD catheter placement technique. A. Initial catheter survival. Log-rank (Mantel-Cox) Test:0.08903; Hazard Ratio:0.9026; 95% CI of ratio:0.4603 to 1.770. B. True catheter survival. Log-rank (Mantel-Cox) Test:0.2232; Hazard Ratio:0.7518; 95% CI of ratio:0.2302 to 2.455. Survival did not significantly differ between the “Half-Perc” technique and open surgery groups
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