Laparoscopic versus open insertion of peritoneal dialysis catheters in pediatric patients: A systematic review and meta-analysis

Infographic · Oct 2025 · 1 min read

In brief

Systematic review of 659 pediatric patients comparing laparoscopic versus open Tenckhoff catheter placement for peritoneal dialysis. Laparoscopic approach demonstrated significantly lower rates of reoperation and peritonitis, with no differences in other complications, suggesting it may be the preferred technique for pediatric PD catheter insertion.

Laparoscopic PD catheter placement reduces reoperation risk by 72% compared to open technique in pediatric patients (OR=0.28, p=0.04)
Peritonitis rates are significantly lower with laparoscopic insertion (OR=0.21, p=0.0006), a critical advantage for long-term dialysis success
No significant difference in catheter migration, obstruction, or exit-site infections between laparoscopic and open approaches
Laparoscopic technique may be preferred method for Tenckhoff catheter placement in children with ESRD based on meta-analysis of 659 patients
Enhanced visualization during laparoscopy allows adjunctive procedures that may improve catheter longevity and reduce complications

Written by the GCMD Library team from the infographic.

Marcella Mota Constante, Letizia Corbi, Maria Luísa Maffioletti, Kayla Dalva Damasceno Bispo dos Santos, Ashwin Pimpalwar

Background: Peritoneal dialysis (PD) is frequently preferred for pediatric patients with end-stage renal disease due to its feasibility for home care and superior quality of life. Proper placement of the Tenckhoff catheter is critical for PD success, yet catheter-related complications remain a major concern. Laparoscopic techniques have gained popularity due to enhanced visualization and potential for adjunctive procedures, which may enhance catheter longevity.

Objective: To compare the effectiveness and safety of laparoscopic versus open surgical placement of Tenckhoff catheters in pediatric patients.

Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, EMBASE, and Cochrane were searched through May 2025. Eligible studies compared laparoscopic and open PD catheter placement in patients under 18 years. Odds ratios (ORs) were calculated using random-effects models. Risk of bias was assessed using ROBINS-I.

Results: Nine observational studies comprising 659 patients were included (laparoscopy: 288; open surgery: 371). Laparoscopic placement significantly reduced the odds of reoperation (OR = 0.28; 95 % CI: 0.08–0.97; p = 0.0444) and peritonitis (OR = 0.21; 95 % CI: 0.09–0.52; p = 0.0006). The pooled analysis of all outcomes also favored the laparoscopic approach (OR = 0.55; 95 % CI: 0.33–0.90; p = 0.0175). No significant differences were observed for catheter migration, obstruction, exit-site infection/tunnel infection and pericatheter leakage.

Conclusions: Laparoscopic catheter insertion is associated with lower risks of reoperation and peritonitis and may be considered the preferred approach. Further prospective, randomized studies are warranted to confirm these benefits