title: Fluoroscopic versus laparoscopic implantation of peritoneal dialysis catheters: a retrospective cohort study.
abstract: OBJECTIVE
  A previous clinical trial showed that radiologic insertion of first peritoneal dialysis (PD) catheters by modified Seldinger technique is noninferior to laparoscopic surgery in patients at low risk in a clinical trial setting. The present cohort study was performed to confirm clinical effectiveness of radiologic insertion in everyday practice, including insertion in patients with expanded eligibility criteria and by fellows in training.
  
  
  METHODS
  Between 2004 and 2009, 286 PD catheters were inserted in 249 patients, 133 with fluoroscopic guidance in the radiology department and 153 by laparoscopic surgery. Survival analyses were performed with the primary outcome of complication-free catheter survival and secondary outcomes of overall catheter survival and patient survival. Outcomes were assessed at last follow-up, as long as 365 days after PD catheter insertion.
  
  
  RESULTS
  In the radiologic group, unadjusted 365-day complication-free catheter, overall catheter, and patient survival rates were 22.6%, 81.2%, and 82.7%, respectively, compared with 22.9% (P = .52), 76.5% (P = .4), and 92.8% (P = .01), respectively, in the laparoscopic group. Frequencies of individual complications were similar between groups. Adjusting for patient age, comorbidity, and previous PD catheter, the hazard ratio (HR) for catheter complications by radiologic versus laparoscopic insertion is 0.90 (95% confidence interval [CI], 0.62-1.31); the HR for overall catheter survival is 1.25 (95% CI, 0.59-2.65); and that for death is 2.47 (95% CI, 0.84-7.3).
  
  
  CONCLUSIONS
  Radiologic PD catheter insertion is a clinically effective alternative to laparoscopic surgery, although there was poorer long-term survival with radiologic catheter placement, possibly because of preferential selection of radiologic insertion for more frail patients.
authors.affiliation: Departments of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, P.O. Box 37968, Auckland 1151, New Zealand.
authors.forename: Emad
authors.initials: E
authors.lastname: Maher
authors.affiliation: Departments of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, P.O. Box 37968, Auckland 1151, New Zealand.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Wolley
authors.affiliation: Departments of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, P.O. Box 37968, Auckland 1151, New Zealand.
authors.forename: Saib A
authors.initials: SA
authors.lastname: Abbas
authors.affiliation: Radiology, Middlemore Hospital, Counties Manukau District Health Board, P.O. Box 37968, Auckland 1151, New Zealand.
authors.forename: Stewart P
authors.initials: SP
authors.lastname: Hawkins
authors.affiliation: Departments of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, P.O. Box 37968, Auckland 1151, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: mrmarsh@woosh.co.nz.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Marshall
mesh_terms: D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002408:Catheters, Indwelling; D018572:Disease-Free Survival; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome