A peritoneal dialysis catheter can be inserted using laparoscopic (basic or advanced), open surgical, or percutaneous techniques (with or without imaging guidance). Looking at the practice pattern worldwide, Open surgical dissection remains the most common insertion technique (8). The preferred procedure in the current literature is an advanced laparoscopic insertion if the patient has a history of major abdominal surgery or highly suspected intra-abdominal adhesions. This is due to the lowest risk of complications associated with this technique. Regardless of what surgical technique is used, the care of the peritoneal dialysis (PD) catheter after insertion is to make sure that adequate healing of the surgical wound and continued patency of the catheter for eventual initiation of regular peritoneal dialysis. The aim of this study was to look at the practice pattern and outcomes of the novel three-cuff PD catheter insertion at our center from 2015 to 2024. Previous studies have reported significant variation in outcomes based on catheter insertion technique, and to date, no large randomized controlled trials (RCTs) have been performed to establish definitive superiority of one method over the other. The 2019 Japanese Society of Dialysis Therapy Peritoneal Dialysis Guidelines also confirm this lack of high-level evidence, emphasizing the importance of clinical context and expertise in selecting the appropriate technique. Methods: The cross-sectional study included 225 patients with end-stage kidney disease who had undergone PD catheter insertion, either percutaneous or laparoscopic in the nephrology unit at King Fahad Hospital University over nine years, from 2015 to 2024. Results: Our analysis showed that the relative risk of three-month complications was significantly higher in the percutaneous group, particularly involving catheter malfunction, leakage, and hernia. These findings are in line with previous literature supporting laparoscopic techniques for superior placement and reduced early complications. Figure 2 shows the positioning of the catheter after laparoscopic insertion. There was no statistical significance between the two groups in terms of patient characteristics such as sample size, age, hypertension, diabetes mellitus, body mass index, and polycystic kidney disease. However, the study reported a higher prevalence of CHF, greater risk of technique failure, and increased complications at three months in the percutaneous PD catheter group compared to the laparoscopic group. However, the rate of catheter migration and peritonitis was 0% with the use of a three-cuff PD catheter. Conclusion: The availability of both methods and the use of the novel three-cuff PD catheter can help increase the number of patients who may benefit from peritoneal dialysis with the minimum possible complications post-insertion, particularly catheter migration and peritonitis, regardless of which surgical method is used.
Mohamed Nasreldin (Tue,) studied this question.