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Table 3 Laparoscopic surgery compared to open surgery for peritoneal dialysis catheter placement. Patient or population: peritoneal dialysis catheter placement; setting: in patients in Taiwan, Greece, the UK, China, Netherlands, and the USA; intervention: laparoscopic surgery; comparison: open surgery

From: Outcomes after peritoneal dialysis catheter placement by laparoscopic surgery versus open surgery: systematic review and meta-analysis

Outcomes

No. of participants (studies) followed up

Certainty of the evidence (GRADE)

Relative effect (95% CI)

Anticipated absolute effects

Risk with open surgery

Risk difference with laparoscopic surgery

Catheter survival

424 (5 RCTs)

⨁⨁◯◯ lowa,b,c

RR 1.02 (0.92 to 1.13)

770 per 1000

15 more per 1000 (62 fewer to 100 more)

Complications of catheter placement (early complications: leakage)

571 (7 RCTs)

⨁◯◯◯ very lowa,c,d

RR 0.86 (0.25 to 3.02)

81 per 1000

11 fewer per 1000 (61 fewer to 164 more)

Complications of catheter placement (late complications: hernia)

391 (4 RCTs)

⨁◯◯◯ very lowc,e

RR 0.75 (0.21 to 2.72)

31 per 1000

8 fewer per 1000 (24 fewer to 53 more)

PD catheter-related infection (exit site infection and tunnel infection)

262 (4 RCTs)

⨁⨁◯◯ lowa,c

RR 0.99 (0.43 to 2.29)

83 per 1000

1 fewer per 1000 (47 fewer to 107 more)

Requirement for re-operation

90 (1 RCT)

⨁⨁⨁◯ moderatec

RR 0.96 (0.39 to 2.33)

182 per 1000

7 fewer per 1000 (111 fewer to 242 more)

Postoperative pain—the number of patients complaining of pain

127 (2 RCTs)

⨁◯◯◯ very lowf,g,h

RR 1.05 (0.80 to 1.39)

446 per 1000

22 more per 1000 (89 fewer to 174 more)

Postoperative pain—assessed by a pain scale

45 (1 RCT)

⨁◯◯◯ very lowf,g,i

–

The mean pain scale was 0

MD 1 lower (2.24 lower to 0.24 higher)

Hospitalization period associated with catheter placement

212 (3 RCTs)

⨁◯◯◯ very lowa,j,k

–

The mean hospitalization period associated with catheter insertion was 0

MD 0.83 higher (0.04 higher to 1.61 higher)

Catheter migration

526 (6 RCTs)

⨁⨁⨁◯ moderatea

RR 0.42 (0.18 to 0.96)

120 per 1000

69 fewer per 1000 (98 fewer to 5 fewer)

Catheter migration: limited to RCTs containing laparoscopic surgery without secured suture

431 (4 RCTs)

⨁⨁⨁◯ moderatea

RR 0.58 (0.27 to 1.25)

103 per 1000

43 fewer per 1000 (75 fewer to 26 more)

Catheter migration: limited to RCTs containing laparoscopic surgery with secured suture

95 (2 RCTs)

⨁⨁⨁◯ moderatea

RR 0.09 (0.01 to 0.68)

200 per 1000

182 fewer per 1000 (198 fewer to 64 fewer)

  1. GRADE Working Group grades of evidence: high certainty—we are very confident that the true effect lies close to that of the estimate of the effect; moderate certainty—we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; low certainty—our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect; very low certainty—we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
  2. aThe randomization methods were not stated in three studies (Jwo et al [7], Xu et al. [8], Qiao et al. [9])
  3. bBecause there were studies with different intervention methods, i.e., peritoneoscopy, and there was concern about the outcome measurements, the rate of imprecision was lowered
  4. cWe evaluated on the assumption that the intervention choice differs with the difference in risk ratio of 2%. The 95% CI crossed the threshold, so we decided to lower the rate of imprecision
  5. dBecause of considerable heterogeneity (I2 = 52%), there was concern, and we decided to lower the level of inconsistency
  6. eAll four studies were at high risk of bias from concerns with regards to allocation concealment
  7. fThe randomization method was not stated
  8. gBecause of the alternative outcome of quality of life
  9. hWe evaluated on the assumption that the intervention choice differs with a risk ratio difference of 10%. The 95% CI crossed the threshold, and we decided to lower the rate of imprecision
  10. iThe details of the pain scale were not stated
  11. jBecause there was a difference in hospitalized duration greater than 10 days among studies and the discharge standards were unclear, we decided to lower the level
  12. kWe assumed that the difference of three days hospitalization might facilitate the choice of intervention. The 95% CI does not cross the threshold, but it was decided to lower by one level because the number of cases is small
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Renal Replacement Therapy

ISSN: 2059-1381

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