Laparoscopic versus open peritoneal dialysis catheter insertion in treatment of aging patients with end stage renal disease

Objective To compare the therapeutic effect and prognosis of two peritoneal dialysis catheter placement techniques in aging patients with end stage renal disease (ESRD):laparoscopic and open peritoneal dialysis techniques. Methods A total of 86 aging patients (over 45 years of age) with ESRD were reviewed between April, 2011 and April, 2016 in Zhejiang Province People's Hospital. Of 86 patients, the open technique was utilized in 54 (group A) and advanced laparoscopy in 32 (group B). Demographic data, medical, operative, postoperative findings, and information about complications 6 months after peritoneal dialysis were compared between these two groups. Results The mean age of patients was (63.6±10.9) years in A group and (57.7±8.7) years in B group (P=0.011). Patients in A group versus B group demonstrated no significant difference in gender, primary disease, diabetes, or hypertension.Patients with past abdominal operation history accounted for 1.9% (1/54) in group A and 18.8% (6/32) in group B (P=0.018). The average hospitalization time after operation was significantly longer in A group than in B group[(12.95±7.10) days vs. (8.93±4.03) days], P=0.001. The incidence of catheter migration was 16.7% (9/54) in A group and 0% (0/32) in B group (P=0.038). Estimated catheter survival at 5 years was 66.2% in the A group compared to 78.7% in the B group respectively, with no significant difference (P=0.852). Conclusion Laparoscopic PD catheter implantation significantly decreased the probability of migration and shortened hospitalization time. Thus, laparoscopic catheter placement may be superior to open surgery in peritoneal dialysis catheter placement of aging patients with past abdominal operation history.