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
