A Nationwide Comparative Analysis of Peritoneoscopic and Laparoscopic Techniques for Peritoneal Dialysis Catheter Insertion in Brunei Darussalam

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 PDC inserted from 1st January 2015 to 31st December 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 PD therapy. Results: During the study period, 145 PDC were inserted. 49 (33.8%) were by peritoneoscopy and 96 (66.2%) laparoscopy. The median time on PD therapy was 54.2 months. Those with a higher BMI 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 post-operative pain observed in the peritoneoscopic group than in the laparoscopic group (8.2% vs 1.0%, p = 0.045). During the study period, there were 49 dropouts to HD, about half were due to infection. However, there was no statistically significant difference observed in time on PD therapy between the two groups (HR 0.87 in laparoscopic group compared to peritoneoscopic group, 95% CI 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, with regards to our PDC insertion experience, with the aim to sustain PD growth in the country.