title: Percutaneous versus surgical insertion of PD catheters in dialysis patients: a meta-analysis.
abstract: OBJECTIVE
  Several small studies have suggested that the percutaneous method of peritoneal dialysis (PD) catheter insertion is effective and has a lower complication rate than surgical techniques (open, laparoscopic or peritoneoscopic), although no randomized, controlled study has compared these methods. Our objective was to compare percutaneous PD catheter insertion vs surgical placement in terms of 1-year catheter survival, catheter dysfunction, fluid leak and incidence of peritonitis.
  
  
  METHODS
  We searched Medline for English-language literature from 1966 through June 2014, along with national conference proceedings and reference lists of all included publications to identify relevant studies. Inclusion criteria were having a measure of catheter survival at 1 year, catheter dysfunction, peritonitis rate per patient-month or fluid leak as outcomes. Studies were excluded if they were not in English or if they included pediatric patients. Random effects models were used to derive the pooled risk ratios, differences in patency and their variations.
  
  
  RESULTS
  Thirteen studies with a total of 2,681 subjects met the inclusion criteria. There was no significant difference in 1-year catheter survival in percutaneous vs surgical PD catheter placement (relative risk [RR] = 0.81; 95% confidence interval [CI]: 0.59-1.11, p = 0.19). Catheter dysfunction also did not differ significantly between the groups (pooled odds ratio [OR] = 0.86; 95% CI: 0.57-1.29, p = 0.46). The prevalence of peritoneal fluid leak also was similar for percutaneous and surgical groups (OR = 1.10; 95% CI: 0.58-2.09, p = 0.77). However, there was a significant lower incidence of peritonitis among those with percutaneous placement (incidence rate ratio [IRR] = 0.77; 95% CI: 0.62-0.96, p = 0.02). Significant heterogeneity was detected across studies (I2 = 78.4%, p&lt;0.0001).
  
  
  CONCLUSIONS
  Our results suggest that there is no significant difference in catheter survival between percutaneous and surgical placement of PD catheters. Whether there are significant benefits from percutaneous placement in terms of peritonitis rates requires further robust studies. These findings have significant implications for future design of clinical trials in the placement of PD catheters and the delivery of dialysis-related services.
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Lamya
authors.initials: L
authors.lastname: Boujelbane
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Fu
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chapla
authors.affiliation: Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: David
authors.initials: D
authors.lastname: Melnick
authors.affiliation: Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Sana
authors.initials: S
authors.lastname: Waheed
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Jung-Im
authors.initials: JI
authors.lastname: Shin
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.|Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.affiliation: Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Micah R
authors.initials: MR
authors.lastname: Chan
mesh_terms: D055499:Catheter-Related Infections / Q000382:microbiology; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D010538:Peritonitis / Q000382:microbiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome