Peritoneal Dialysis Catheter Placement: A Call for Universal Acceptance of the Laparoscopic Technique

Tiffany C Cox, MD, Laurel J Blair, MD, Ciara R Huntington, MD, Tanushree Prasad, MA, Kent W Kercher, MD, FACS, Vedra A Augenstein, MD, FACS, B. Todd Heniford, MD, FACS. Carolinas Medical Center

Introduction: Laparoscopy has become the standard for many General Surgery procedures by decreasing hospital stay, minimizing recovery time, and reducing wound infection rates. This study evaluates potential benefits of the laparoscopic approach to peritoneal dialysis catheter (PDC) placement.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for laparoscopic and open PDC placement. We evaluated patient demographics, comorbidities, operative time, length of stay (LOS), and postoperative outcomes. Univariate comparison and multivariate logistic regression analysis (MVA) adjusting for confounding factors including age, body mass index (BMI), and comorbidities were performed.

Results: A total of 3,134 patients underwent PDC placement between 2005-2012: 2,412 laparoscopic cases (LPDC) and 722 open (OPDC). Overall, the majority of cases were performed by General Surgeons (81%) while the next most common were completed by vascular surgeons (16.8%). Patients undergoing LPDC vs. OPDC demonstrated no significant difference in gender (54% vs 56% males, p=0.4), smoking (8.5±18.3 vs7.2±16.9 pack years, p=0.06), diabetes (42% vs 40%, p=0.4), COPD (4.5% vs 4.9%, p=0.6), dialysis requirement (72% vs 73%,p=0.6), but younger (57 vs 58 years, p=0.05) and higher BMI (29.3 vs 29kg/m2,p=0.04) patients tended to have LPDC. In univariate analysis of LPDC vs. OPDC, wound complications (1.6% vs 2.9%, p=0.02), minor complications (3.8% vs 6.5%, p=0.002), and major complications (4.3% vs 6.9%, p=0.004) favored the LPD approach, but rate of all postoperative complications were equivalent after MVA (p>0.05). On MVA, operative time was less in LPDC vs. OPDC (55.8±38.8 vs 68±73.1 minutes, p<0.001) and LOS appeared shorter, but was statically no different after controlling for confounding factors (1.8±11.9 vs 4.4±10 days, p=0.29). Both LPD and OPD had low rates of catheter failure with no difference between techniques identified (0.21% vs 0.14%, p=0.7).

Conclusion: Benefit from laparoscopic technique in peritoneal dialysis catheter placement is observed by shorter operative times, comparable length of stay, and similar rates of postoperative complications in this comorbid patient population. However, continued adoption, dispersal, and refinement of the laparoscopic approach may further optimize patient outcomes.

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