Outcomes of modified single trocar laparoscopic catheter placement for maintenance peritoneal dialysis in children

Peritoneal dialysis (PD) access remains a major challenge in pediatric kidney replacement therapy. Although laparoscopic approaches are increasingly favored, pediatric evidence regarding single-trocar placement remains limited.

This retrospective cohort study included children with kidney failure or advanced chronic kidney disease who underwent a modified single-trocar laparoscopic Tenckhoff catheter insertion between January 2020 and November 2021. All required urgent-start PD on the day of insertion. The technique used a transumbilical 10-mm operative laparoscope, oblique left rectus sheath tunneling, Douglas pouch positioning, selective partial omentectomy, abdominal wall and deep cuff fixation, and it minimized redundant intraperitoneal catheter length. The primary clinical endpoint was transplant-censored catheter-related failure-free survival, and mechanical catheter patency was the key technique-specific secondary endpoint.

Nineteen children underwent the procedure. Median follow-up was 58.2 months, representing 34,109 catheter-days at risk. No perioperative complications, pericatheter leakage, hernias, or catheter migration occurred. Transplant-censored catheter-related failure-free survival was 67.4% at 1 year and 61.8% from 2 through 5 years. Mechanical patency was 88.1% from 1 through 5 years. Ten catheter replacements occurred: six for refractory methicillin-resistant Staphylococcus aureus exit-site infection, two for fungal peritonitis, and two for omental wrapping. Both omental obstruction events occurred among the five children who did not undergo partial omentectomy.

The modified technique achieved favorable mechanical durability despite same-day urgent-start PD. Infection-related events remained the principal cause of catheter replacement, highlighting the need to optimize infection-prevention protocols alongside operative technique.