Laparoscopic Versus Open Peritoneal Dialysis Catheter Insertion: A Meta-analysis

Objective: Continuous ambulatory peritoneal dialysis(CAPD)is an effective and safe form of treatment for patients with end-stage renal failure, permanent peritoneal dialysis access was first described and introduced in clinical practice more than 40 years ago, It is still undergoing modification and adaptation to various insertion techniques. The usage of laparoscopic catheter placement technique was increased in recent years. But the advantages and disadvantages between the laparoscopic catheter placement technique and open laparotomy technique were still in controversy. The objective of this meta-analysis was carried out to investigate if one of the techniques is superior to the other.Methods: Comprehensive searches were conducted in MEDLINE, Embase, and Cochrane Library. Chinese Biomedical Database, CNKI, Analysis was performed using the statistical software Stata Version 12.0.Results: 4 randomized controlled trials and 18 cohort studies were identified, involving 2323 patients. The use of loparoscopic insertion technique significantly decreased the risk of migration( RR=0.341,95%CI 0.229~0.507; P=0.000)and obstruction(RR=0.402,95%CI 0.273~0.592; P=0.000), but increased the one-year catheter survival(RR=1.232,95%CI 1.124~1.351; P=0.000) and two-year catheter survival(RR=1.361,95%CI 1.158~1.599; P=0.000).Conclusion: The data clearly demonstrates that loparoscopic catheter placement had superiority to open surgery in such as less migration and a highter one-year and two-year catheter survival.