Outcomes of fluoroscopic and ultrasound-guided placement versus laparoscopic placement of peritoneal dialysis catheters

Abstract

Background: Several peritoneal dialysis catheter (PDC) placement techniques have been described. The objective of this study was to compare the fluoroscopy and ultrasound guidance technique with the laparoscopic technique. Methods: We retrospectively reviewed the medical records of 260 patients who had their first PDC placed between January 2005 and June 2016. We compared the outcomes of the fluoroscopic and ultrasound-guided catheter placement technique (radiologic group, n ¼ 50) with the laparoscopic catheter placement technique (laparoscopic group, n ¼ 190). The primary endpoint was complication-free catheter survival at 365 days. Secondary endpoints were complication-free catheter survival at 90 days, overall catheter survival at 90 and 365 days, median days to first complication and median days to catheter removal. Results: In the radiologic group, the complication-free catheter survival at 90 and 365 days was 64% and 48%, respectively, while in the laparoscopic group it was 71% (P ¼ 0.374) and 53% (P ¼ 0.494), respectively. Catheter malfunction was significantly higher in the laparoscopic group (30%) compared with the radiologic group (16%, P ¼ 0.048). The overall catheter survival at 90 and 365 days was 76% and 52%, respectively, in the radiologic group, while in the laparoscopic group it was 88% (P ¼ 0.0514) an 48% (P ¼ 0.652), respectively. There was no significant difference in the median days to first complication and the median days to catheter removal between the two groups (P ¼ 0.71). Conclusion: The technique of fluoroscopic and ultrasound-guided PDC placement is a clinically effective and safe alternative to laparoscopic catheter placement with similar survival and complication rates.