title: Laparoscopic versus open peritoneal dialysis catheter insertion: a meta-analysis.
abstract: BACKGROUND
  Peritoneal dialysis is an effective treatment for end-stage renal disease. Key to successful peritoneal dialysis is a well-functioning catheter. The different insertion techniques may be of great importance. Mostly, the standard operative approach is the open technique; however, laparoscopic insertion is increasingly popular. Catheter malfunction is reported up to 35% for the open technique and up to 13% for the laparoscopic technique. However, evidence is lacking to definitely conclude that the laparoscopic approach is to be preferred. This review and 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 CENTRAL (the Cochrane Library 2012, issue 10). Reference lists were searched manually. The methodology was in accordance with the Cochrane Handbook for interventional systematic reviews, and written based on the PRISMA-statement.
  
  
  RESULTS
  Three randomized controlled trials and eight cohort studies were identified. Nine postoperative outcome measures were meta-analyzed; of these, seven were not different between operation techniques. Based on the meta-analysis, the proportion of migrating catheters was lower (odds ratio (OR) 0.21, confidence interval (CI) 0.07 to 0.63; P = 0.006), and the one-year catheter survival was higher in the laparoscopic group (OR 3.93, CI 1.80 to 8.57; P = 0.0006).
  
  
  CONCLUSIONS
  Based on these results there is some evidence in favour of the laparoscopic insertion technique for having a higher one-year catheter survival and less migration, which would be clinically relevant.
authors: Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Sander M
authors: SM
authors: Hagen
authors: Jeffrey A
authors: JA
authors: Lafranca
authors: Ewout W
authors: EW
authors: Steyerberg
authors: Jan N M
authors: JN
authors: Ĳzermans
authors: Frank J M F
authors: FJ
authors: Dor
mesh_terms: D057785:Catheters / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D016019:Survival Analysis; D016896:Treatment Outcome