Anterior Abdominal Wall Pexy Stitch During Laparoscopic Peritoneal Dialysis Catheter Insertion Improves 1-Year Reoperation Rates

Background Peritoneal dialysis (PD) is an increasingly popular renal replacement therapy, but catheter obstruction or migration can compromise patency. Catheter pexy (CP) and omentopexy have been described as prophylactic adjuncts to increase patency but not studied in a large cohort. We hypothesized that prophylactic CP would be associated with decreased one-year PD catheter reoperation. Methods This retrospective cohort study included patients aged 18-89 who underwent PD catheter insertion at a single tertiary care facility between 2016 and 2023. The primary exposure was CP during PD catheter insertion. The primary outcome was one-year reoperation (removal or revision). Covariates included demographics, obesity classification, comorbidities, and concomitant omentopexy. Propensity-score matching (1:3 nearest neighbor method) analyzed the association of CP with 1-year catheter patency. Results Of 524 patients identified, 429 were included in the baseline cohort. Of those, 327 (76.2%) had prophylactic CP and 102 (23.8%) did not. Baseline characteristics were similar, except more frequent concomitant omentopexy in the CP group (36.1% vs 19.6%; P = 0.003). After excluding reoperations due to infection (n = 40) and fibrin plugging (n = 17), unadjusted one-year reoperation rates were lower for the CP group (11.8% vs 20.4%; P = 0.04). Estimated by inverse probability weighted regression adjustment, CP was associated with a 10.2% [95% CI −19.9% to −0.4%] decrease in one-year reoperation. Conclusion This large cohort study is the first to demonstrate that prophylactic CP improves one-year PD catheter patency. Prospective randomized trials are warranted to establish the benefit of prophylactic CP.