Outcomes after peritoneal dialysis catheter placement

doi:10.1016/j.jpedsurg.2016.02.011

Journal of Pediatric Surgery

Volume 51, Issue 5, May 2016, Pages 730-733

https://doi.org/10.1016/j.jpedsurg.2016.02.011 Get rights and content

Abstract

Background

The purpose of this study was to review surgical outcomes after elective placement of peritoneal dialysis (PD) catheters in children with end-stage renal disease.

Methods

Children with PD catheters placed between February 2002 and July 2014 were retrospectively reviewed. Outcomes were catheter life, late (> 30 days post-op) complications (catheter malfunction, catheter malposition, infection), and re-operation rates. Comparison groups included laparoscopic versus open placement, age < 2, and weight < 10 kg. Univariate and multivariate analysis were performed.

Results

One hundred sixteen patients had 173 catheters placed (122 open, 51 laparoscopic) with an average patient age of 9.7 ± 6.3 years. Mean catheter life was similar in the laparoscopic and open groups (581 ± 539 days versus 574 ± 487 days, p = 0.938). The late complication rate was higher for open procedures (57% versus 37%, p = 0.013). Children age < 2 or weight < 10 kg had higher re-operation rates (64% versus 42%, p = 0.014 and 73% versus 40%, p = 0.001, respectively). Adjusted for age and weight, open technique remained a risk factor for late complications (OR 2.44, 95% CI 1.20–4.95) but not re-operation.

Discussion

Laparoscopic placement appears to reduce the rate of late complications in children who require PD dialysis catheters. Children < 2 years age or < 10 kg remain at risk for complications regardless of technique.

Section snippets

Study design

Data from all patients who underwent PD catheter placement at Texas Children's Hospital between February 1, 2002 and July 1 2014 were reviewed retrospectively. Patients were identified from the hospital's surgical database through procedure codes. Neonates with non-tunneled temporary peritoneal dialysis catheters and patients with acute renal failure were excluded. Children with previous renal transplantation or abdominal surgery were not excluded. Data collected consisted of the following

Demographics and surgical outcomes

During the study period, 116 patients had 173 catheters placed (122 open, 51 laparoscopic). Patient demographics and catheter characteristics are listed in Table 1. Patients ranged in age from 2 days to 22 years with an average age of 9.7 ± 6.3 years. Overall, patients with open catheter placement were younger (9.0 ± 6.5 years) compared to the laparoscopic group (11.4 ± 5.7 years, p = .024). However, both groups had a similar number of children younger than age 2 (25% vs. 16%, p = 0.08). Focal segmental

Discussion

Peritoneal dialysis is the preferred method of dialysis in children with ESRD. Double cuffed tunneled catheters in children > 2 years of age are now the standard in our group as many studies have demonstrated decreased complication rates. Infectious complications remain the primary complication of PD catheter placement in this and other studies [3], [4]. We have demonstrated that a laparoscopic approach leads to increased catheter duration and appears to be beneficial in reducing complications

Conclusion

Peritoneal dialysis remains the preferred method of dialysis for pediatric patients with ESRD. We have demonstrated that laparoscopic placement appears to have benefit in reducing the rate of late complications and reoperation rates although children < 2 years age or < 10 kg remain at high risk for complications and re-operations regardless of technique. It is therefore appropriate to employ laparoscopic catheter insertion techniques when feasible to improve outcomes in children with ESRD.

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Cited by (22)

An overview of pediatric peritoneal dialysis and renal replacement therapy in infants: A review for the general pediatric surgeon
2022, Seminars in Pediatric Surgery
Citation Excerpt :
Similar to the lack of large data on omentectomy, there is very little in the published literature commending a laparoscopic approach over an open approach, but there does seem to be evidence that the laparoscopic approach increases the length of time to first peritonitis episode and decreased the risk of early complications in children > 2 years old. There are several small studies that report satisfactory outcomes with laparoscopic peritoneal dialysis catheter insertion17-20. One of the potential advantages noted with laparoscopy is the ability to more precisely position the catheter in the pouch of Douglas, it can be used to salvage catheters and address adhesions and other intra-abdominal pathology more easily than the open technique20.
Currently, there are about 10,000 pediatric patients in the United States who rely on dialysis for renal replacement therapy. Dialysis allows children with chronic kidney disease a means of support until renal transplant is feasible. All forms of renal replacement therapy require a surgical intervention, whether the modality is hemodialysis or peritoneal dialysis. Despite peritoneal dialysis being the most common modality of dialysis in children, there is not prospectively collected much evidence in the literature which can guide the pediatric surgeon about best practices on access placement, management of complications, and timing of removal. Most available studies are small, single-center retrospective reviews. This limits the power of the data collected to help guide decision-making in the management of peritoneal dialysis catheters.
The purpose of this review is to provide a consolidated source of best available evidence and identify important areas for future study. Furthermore, this is an area of pediatric surgical care that lacks up to date outcomes research with robust surgeon participation. Lack of coordinated, evidence-based best practices likely results in heterogenous surgical practices and uneven strategies for managing complications. Furthermore, with improvements in neonatal critical care and fetal interventions available for obstructive uropathies and other congenital kidney disorders, there is increased likelihood of the need for dialysis access in more infants, who represent a particularly vulnerable patient population. Importantly, peritoneal dialysis access should be instituted into the national PEDScore curriculum for pediatric surgical fellows, as this procedure is common enough that any pediatric surgeon could be consulted for catheter placement and management. Surgeon awareness of, and participation in the formulation, of guidelines and prospective studies is of paramount importance to ensure optimal care of this vulnerable population of children.
A standardized technique of laparoscopic placement of peritoneal dialysis catheter with omentectomy and closure of patent processus vaginalis: A 3-in-1 minimally invasive surgical approach in children
2020, Journal of Pediatric Surgery
Citation Excerpt :
Catheter obstruction by omental wrapping is a common reason for catheter failure, and recent literature has reported catheter obstruction rates of 26 to 36% [3,6,10]. Performing omentectomy at the time of PD catheter placement has been suggested by some investigators [2,3,5,8] but not the others [4,7,11]. Current evidence in published literature is short of the strength to make recommendations [10].
Omental wrapping is a common cause for catheter failure in children on peritoneal dialysis (PD). Previous studies are conflicting in the benefits of omentectomy.
We conducted a retrospective study comparing children who underwent PD catheter placement by a standardized laparoscopic three-in-one technique (lap3-in-1) from 2013 to 2018 versus a historical control cohort by open surgery without omentectomy. Lap3-in-1technique combined catheter placement with well-defined indication and extent of omentectomy, and closure of any patent processus vaginalis (PPV).
There were 33 and 32 children in the lap3-in-1 and control cohorts respectively. 4/33(12.1%) in lap3-in-1 had reoperations for catheter failures which equated 1 reoperation per 144 catheter months. No reoperations were performed in lap3-in-1 cohort for omental wrapping or inguinal hernia, compared with 13/32 (41%; p < 0.001) and 5/32 (16%; p = 0.02) in the control cohort. Kaplan Meier survival curves showed significantly longer catheter life in the lap3-in-1 cohort (p < 0.001). In multivariate analysis by the COX proportional hazards model, the lap3-in-1 approach had significantly reduced risk of reoperation for catheter failure (HR 0.11; 95% CI: 0.04–0.31; p < 0.001).
The lap3-in-1 technique is effective in selecting those children who would benefit from omentectomy, and avoiding a second operation for inguinal hernia which develops after PD.
Treatment study, level III
Factors associated with early peritoneal dialysis catheter malfunction
2019, Journal of Pediatric Surgery
Citation Excerpt :
In a recent survey of pediatric surgeons in North America, only 15% reported using a laparoscopic technique for a first PD catheter placement [1]. No studies have shown a benefit of laparoscopic surgery over open surgery in the pediatric population [21,23,25]. One study reported a significant increase in late complications and reoperation rates using an open procedure [21].
Peritoneal dialysis (PD) catheter obstruction often leads to surgical revision and may require transition to hemodialysis. The purpose of this study was to evaluate risk factors (including omentectomy) associated with early PD catheter obstruction (< 6 months from insertion).
A retrospective review of all PD catheters inserted at a single high-volume referral center (2005–2018) was performed. 185 PD catheters were placed in 123 patients (45 female). Potential risk factors for early catheter obstruction were analyzed using Chi-square analysis (p < 0.05 considered statistically significant).
Median age at catheter insertion was 3.42 years (3 days–39 years). Early catheter obstruction occurred in 42 cases (22.7%). Median time to early obstruction was 24 days (3–118 days). Previous PD catheter placement (p = 0.9) or prior abdominal surgery (p = 0.89) was not associated with obstruction. Weight ≥ 10 kg (p = 0.011) and age ≥ 1 year (p = 0.048) were associated with a significantly higher incidence of obstruction. Overall, omentectomy was associated with a trend in reduction of early obstruction in patients with weight ≥ 10 kg (p = 0.08) and significantly in patients ≥ 1 year (p = 0.028).
Early PD catheter obstruction appears to occur more often in older patients with a higher weight. Concomitant omentectomy seems beneficial at reducing early catheter obstruction events in those patients.
Retrospective comparative study.
III.
SAGES peritoneal dialysis access guideline update 2023
2024, Surgical Endoscopy
Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis
2023, Pediatric Nephrology
Stratification of Risk Factors of Complications Associated with Peritoneal Dialysis Catheter Placement
2023, Journal of Laparoendoscopic and Advanced Surgical Techniques

View all citing articles on Scopus

^☆: Level of Evidence: 2c.

^☆☆: Disclosures: The authors have no sources of support or financial relationships to disclose with respects to the preparation of this manuscript.

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CAPS PaperOutcomes after peritoneal dialysis catheter placement☆,☆☆

Abstract

Background

Methods

Results

Discussion

Section snippets

Study design

Demographics and surgical outcomes

Discussion

Conclusion

J Pediatr Surg

Am J Surg

J Surg Res

J Urol

J Pediatr Surg

Sem Nephrol

Peritoneal dialysis access: open versus laparoscopic surgical techniques

J Vasc Access

Clinical practice guidelines for pediatric peritoneal dialysis

Pediatr Nephrol

Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update

Perit Dial Int

Catheter-related interventions to prevent peritonitis in peritoneal dialysis: a systematic review of randomized, controlled trials

JASN

Surgical technique for peritoneal dialysis

Adv Perit Dial

CAPS Paper
Outcomes after peritoneal dialysis catheter placement☆,☆☆