Jin K Kim1,2, Marisol Lolas3, Daniel T Keefe3, Mandy Rickard3, Priyank Yadav3, Jessica M Ming4, Karen Milford5, Martin A Koyle6,3, Armando J Lorenzo6,3, Michael E Chua6,3,7. 1. Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada. jjk.kim@mail.utoronto.ca. 2. Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. jjk.kim@mail.utoronto.ca. 3. Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. 4. Division of Urology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA. 5. Division of General Surgery, Department of Surgery, Nelson Mandela Children's Hospital, Johannesburg, South Africa. 6. Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada. 7. Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
Abstract
OBJECTIVES: Peritoneal dialysis (PD) is an option for ultrafiltration for patients with end-stage renal disease. Once placed, PD catheters may malfunction often due to omental wrapping. Omental procedures such as omentectomy and omentopexy may reduce this risk. This investigation aims to perform a systematic review and meta-analysis of the literature on the role of omental procedures on PD catheter insertions. METHODS: Following protocol registration on PROSPERO (CRD42020218950), a systematic review was performed in accordance with the Cochrane Collaboration. A literature search was performed in February 2021 across Medline, EMBASE, Scopus, and Cochrane Library. Records with patients who underwent PD catheter insertion with and without omental manipulation were included. The records underwent screening, full-text review, and data extraction. Study qualities were assessed using RoBINS-I and RoB2. Effect estimates were extracted as risk ratios and corresponding 95% confidence intervals (CI) were pooled using inverse variance method with random-effect model. RESULTS: Of 510 records identified, 15 studies were included in the meta-analysis (1 RCT, 2 prospective, 12 retrospective). With omental procedures, there was decreased the likelihood of failure requiring removal of PD catheter (RR 0.47, 95% CI 0.38, 0.58) and PD catheter obstruction (RR 0.23, 95% CI 0.14, 0.39); there was no difference in likelihood of catheter malposition or migration (RR 0.87, 95% CI 0.23, 3.29) or peritonitis (RR 0.74, 95% CI 0.40, 1.35). CONCLUSION: Based on the current low to moderate quality of evidence, omental manipulation at the time of PD catheter insertion confers benefits of decreased obstruction and failure requiring removal.
OBJECTIVES: Peritoneal dialysis (PD) is an option for ultrafiltration for patients with end-stage renal disease. Once placed, PD catheters may malfunction often due to omental wrapping. Omental procedures such as omentectomy and omentopexy may reduce this risk. This investigation aims to perform a systematic review and meta-analysis of the literature on the role of omental procedures on PD catheter insertions. METHODS: Following protocol registration on PROSPERO (CRD42020218950), a systematic review was performed in accordance with the Cochrane Collaboration. A literature search was performed in February 2021 across Medline, EMBASE, Scopus, and Cochrane Library. Records with patients who underwent PD catheter insertion with and without omental manipulation were included. The records underwent screening, full-text review, and data extraction. Study qualities were assessed using RoBINS-I and RoB2. Effect estimates were extracted as risk ratios and corresponding 95% confidence intervals (CI) were pooled using inverse variance method with random-effect model. RESULTS: Of 510 records identified, 15 studies were included in the meta-analysis (1 RCT, 2 prospective, 12 retrospective). With omental procedures, there was decreased the likelihood of failure requiring removal of PD catheter (RR 0.47, 95% CI 0.38, 0.58) and PD catheter obstruction (RR 0.23, 95% CI 0.14, 0.39); there was no difference in likelihood of catheter malposition or migration (RR 0.87, 95% CI 0.23, 3.29) or peritonitis (RR 0.74, 95% CI 0.40, 1.35). CONCLUSION: Based on the current low to moderate quality of evidence, omental manipulation at the time of PD catheter insertion confers benefits of decreased obstruction and failure requiring removal.
Authors: Gordon Guyatt; Andrew D Oxman; Elie A Akl; Regina Kunz; Gunn Vist; Jan Brozek; Susan Norris; Yngve Falck-Ytter; Paul Glasziou; Hans DeBeer; Roman Jaeschke; David Rind; Joerg Meerpohl; Philipp Dahm; Holger J Schünemann Journal: J Clin Epidemiol Date: 2010-12-31 Impact factor: 6.437