Omental Procedures During Peritoneal Dialysis Insertion: A Systematic Review and Meta-Analysis

• Published in: World journal of surgery Vol. 46; no. 5; pp. 1183 - 1195
• Main Authors: Kim, Jin K., Lolas, Marisol, Keefe, Daniel T., Rickard, Mandy, Yadav, Priyank, Ming, Jessica M., Milford, Karen, Koyle, Martin A., Lorenzo, Armando J., Chua, Michael E.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-05-2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Cardiac Surgery; Catheterization - methods; Catheters; Catheters, Indwelling; Confidence intervals; Dialysis; End-stage renal disease; General Surgery; Humans; Insertion; Kidney diseases; Medical instruments; Medicine; Medicine & Public Health; Meta-analysis; Peritoneal dialysis; Peritoneal Dialysis - methods; Peritoneum; Peritonitis; Prospective Studies; Retrospective Studies; Scientific Review; Surgery; Systematic review; Thoracic Surgery; Ultrafiltration; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-021-06413-9

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.