Laparoscopic versus Conventional Open Peritoneal Dialysis Catheter Insertion in China: A Meta-Analysis.

Purpose: To compare the risk of complications between laparoscopic peritoneal dialysis (PD) catheter placement and open PD catheter placement.

Methods: We searched numerous databases, including SinoMed, CNKI, cqVIP, WanFang, Pubmed, Web of Science, OVID,  Cochrane and Scopus, for published randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) .

Results: Ten studies were included(n=1341). The overall statistical results showed that patients receiving laparoscopic insertion of the PD catheter had a lower risk of catheter migration, inadequate drainage and blockage. The risk of leakage was higher in the laparoscopic group in studies performed prior to 2015; in studies performed after 2015, the risk of leakage was lower than in the conventional open-placement group. For the risk of developing pain, the risk was lower in the subgroup of laparoscopic patients starting PD within 1 day after catheter insertion; however, there was no significant difference between the subgroups starting PD 1 week or 2 weeks after catheter insertion. The risk outcome for abdominal bleeding was similar to that for pain, with a lower risk in the subgroup of laparoscopic patients starting PD within 1 day. The overall research quality was moderate.

Conclusion: Laparoscopic placement of the PD catheter has unique advantages over conventional open surgical placement, especially in special conditions such as emergency initiation. In addition, we found that some factors that were previously considered irrelevant may have an impact on the results for Asians. However, this conclusion still needs to be substantiated by further large samples in multicenter, high quality Randomized Controlled Trials (RCTs).