Optimizing peritoneal dialysis access: a propensity score-matched comparison of open, multi-port, and single-port...

Peritoneal dialysis (PD) is a vital kidney replacement therapy that offers substantial lifestyle advantages and preserves residual renal function. Nevertheless, the long-term success of PD is contingent upon the reliable function and longevity of the peritoneal dialysis catheter (PDC). There is still no high-quality evidence regarding the optimal surgical approach for PDC insertion.

A multicentre, international, retrospective cohort study was conducted on 484 consecutive adult patients undergoing PDC insertion at five centres between 2010 and 2024. Propensity score matching (PSM) was utilized to compare open and laparoscopic groups (139 pairs) and laparoscopic single-port and multi-port groups (72 pairs). The primary endpoints encompassed PDC-specific complications (malfunction, infection, leakage) and surgical morbidity.

Following PSM, the laparoscopic group demonstrated a significantly lower incidence of PDC-specific complications (26.6% vs. 38.8%, p = 0.030) and a reduced necessity for surgical catheter repositioning (6.5% vs. 15.1%, p = 0.032) in comparison to the open group. Patients in the laparoscopic cohort were more frequently managed as day cases (25.9% vs. 12.9%, p = 0.009). In the laparoscopic cohort, the single-port technique was associated with a significantly shorter operative times (43 (IQR 35-60) vs. 55 (IQR 45-65) min, p < 0.001), reduced hospital stay (0 (0-1) vs. 1 (IQR 0) days, p < 0.001), and fewer PDC-specific complications (22.2% vs. 50.0%, p < 0.001) when compared with multi-port access.

Laparoscopic PDC insertion has been shown to result in a lower incidence of malfunction episodes and reduced repositioning rates when compared with open surgery. The single-port laparoscopic approach has been shown to optimise the utilisation of resources by reducing operative times and hospital stays, whilst also potentially minimizing the occurrence of infectious complications.