Outcomes after peritoneal dialysis catheter placement

Area of Science:

• Pediatric Surgery
• Nephrology
• Medical Devices

Background:

• End-stage renal disease (ESRD) in children necessitates renal replacement therapy.
• Peritoneal dialysis (PD) is a common modality for pediatric ESRD.
• Effective PD catheter placement is crucial for successful dialysis outcomes.

Purpose of the Study:

• To evaluate surgical outcomes of elective peritoneal dialysis (PD) catheter placement in pediatric patients.
• To compare laparoscopic versus open surgical techniques for PD catheter insertion.
• To identify risk factors for complications and re-operation in pediatric PD catheter placement.

Main Methods:

• Retrospective review of 116 children with 173 PD catheter placements (February 2002 - July 2014).
• Outcomes assessed: catheter survival, late complications (>30 days post-op), and re-operation rates.
• Comparison groups: laparoscopic vs. open, age <2 years, weight <10 kg; univariate and multivariate analyses performed.

Main Results:

• Mean catheter life was similar between laparoscopic and open groups (581 vs. 574 days).
• Late complication rates were significantly higher with open procedures (57% vs. 37%, p=0.013).
• Children <2 years or <10 kg had higher re-operation rates (64% vs. 42%, p=0.014 and 73% vs. 40%, p=0.001). Open technique was a risk factor for late complications (OR 2.44).

Conclusions:

• Laparoscopic PD catheter placement is associated with a lower rate of late complications in children.
• Younger (<2 years) and smaller (<10 kg) children face increased risks of complications and re-operation, regardless of surgical approach.
• Optimizing surgical technique and patient selection is important for improving PD catheter outcomes in pediatric ESRD.