Different techniques for peritoneal dialysis catheter implantation: A systematic review and network meta-analysis

The current consensus recommended the peritoneal dialysis catheter (PDC) techniques based on the patients' anesthesia situation and previous abdominal surgery. However, the research comparing of all the existing PDC techniques is lacking. The objective was to compare the efficacy and safety of PDC techniques by network meta-analysis (NMA). A systematic review of databases was conducted to identify eligible studies. NMA was used to estimate the ranking for endpoints. Our NMA included 41 studies (9 randomized controlled trials (RCTs) and 32 observational trials) and enrolled 3902 patients, comparing three techniques: the laparoscopic catheterization (LC), open surgery catheterization (OSC), and percutaneous catheterization (PC). NMA in RCTs showed OSC had the highest incidence of catheter mechanical dysfunction, PC and LC were very similar, but this result had no statistical difference. NMA in observational studies showed that LC had the highest 1-year catheter survival but without statistical difference (LC vs. OSC: odds ratio (OR) 1.75, 95% credible intervals (CrIs) 0.90-3.40; PC vs. OSC: OR 1.55, 95% CrIs 0.80-2.97; PC vs. LC: OR 0.88, 95% CrIs 0.54-1.44). OSC had the lowest incidence for bleeding. The complications of leakage, peritonitis, and exit/tunnel infection were inconclusive due to the inconsistent results between RCTs and observational studies. Our NMA revealed LC may have the best 1-year catheter survival. PC and LC might be efficacious in lowering the mechanical dysfunction. OSC had the lowest incidence for bleeding. More RCTs with larger scale and higher quality are needed in order to obtain more credible evidence.