Prospective randomized study for comparison of open surgery with laparoscopic-assisted placement of Tenckhoff peritoneal dialysis catheter--a single center experience and literature review.
BACKGROUND
The ideal method for catheter placement in patients undergoing peritoneal dialysis remains debatable. This prospective study intends to clarify whether laparoscopic assisted percutaneous puncture is superior to open surgery.


METHODS
From 2002 to 2006, 77 patients receiving first catheter placement were enrolled and randomized to either an open group of 40 patients or a laparoscopic group of 37 patients. Patient characteristics, operation-related data, procedural complications, and clinical outcome were compared by using the statistical software SPSS ver. 11.5 (SPSS, Chicago, IL).


RESULTS
Laparoscopy had a longer operative time (68.32+/-31.90 versus 46.68+/-15.99 min; P<0.001), shorter wound length (1.69+/-0.46 versus 2.34+/-0.84 cm; P<0.001), and higher costs (P<0.001) compared with open surgery. Laparoscopy tended to have a higher incidence of pericannular bleeding (21.6% versus 7.5%) and a lower rate of early catheter migration (2.7% versus 15.0%), but its early/late/overall complication rate did not statistically differ. No surgical mortality occurred. Rate and cause of overall mortality or catheter dropout did not statistically differ. Catheter longevity was equivalent in both groups.


CONCLUSIONS
Laparoscopic assisted percutaneous puncture exhibited no superiority to open surgery. As a matter of fact, open surgery's shorter operative time and reduced equipment requirement can increase cost-effectiveness. Therefore, conventional open surgery is recommended for most patients with primary catheter placement.
Jwo
Shyh-Chuan
SC
Division of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC. jowsc@adm.cgmh.org.tw
Chen
Kuo-Su
KS
Lee
Chin-Chan
CC
Chen
Huang-Yang
HY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult