Abstract
KEY POINTS: Peritoneoscopic and laparoscopic peritoneal dialysis catheter insertions are complementary to each other, and each has its niche in a successful peritoneal dialysis program. Future studies need to use standardized definitions to enable comparisons across jurisdictions, and this study is the first to do so. BACKGROUND: Brunei Darussalam introduced peritoneoscopic insertion of peritoneal dialysis catheter (PDC) as a new method in 2014. The aim of this study was to compare outcomes of PDC insertion technique in the country, using proposed standardized definitions of outcomes. METHODS: This study used retrospective analysis of all PDCs inserted from January 1, 2015, to December 31, 2020, in the country. Outcomes of both peritoneoscopic and laparoscopic insertion methods were analyzed. Four main categories of outcomes were assessed—(1) operative-related outcomes, (2) infective outcomes, (3) mechanical outcomes, and (4) time on peritoneal dialysis (PD) therapy. RESULTS: During the study period, 145 PDCs were inserted: 49 (33.8%) were by peritoneoscopy and 96 (66.2%) by laparoscopy. The median time on PD therapy was 54.2 months. Those with a higher body mass index and history of previous abdominal or pelvic surgery were more likely to undergo laparoscopic method. There was no significant difference in overall infective and mechanical outcomes between the two methods. There was however significantly more postoperative pain observed in the peritoneoscopic group than in the laparoscopic group (8.2% versus 1.0%, P = 0.045). During the study period, there were 49 dropouts to hemodialysis, about half were due to infection. However, there was no statistically significant difference observed in time on PD therapy between the two groups (hazard ratio 0.87 in laparoscopic group compared with peritoneoscopic group, 95% confidence interval, 0.49 to 1.54; P=0.636). CONCLUSIONS: Peritoneoscopic and laparoscopic PD catheter insertions are both complementary to each other in our local setting. This study has enabled us to scrutinize our PD program, regarding our PDC insertion experience, with the aim to sustain PD growth in the country.