Evaluating the need for omentectomy during laparoscopic placement of tunneled peritoneal dialysis catheters in pediatrics: a multicenter comparative study.

PURPOSE: To evaluate whether routine omentectomy improves outcomes during laparoscopic placement of peritoneal dialysis (PD) catheters in children.

METHODS

This multicenter retrospective study included children ≤ 5 years who underwent laparoscopic PD catheter insertion (2022-2025). Patients were divided into non-omentectomy (Group A, n = 169) and omentectomy (Group B, n = 182). The primary outcome was catheter survival at 12 months. Secondary outcomes included complications, operative time, and hospital stay.

RESULTS

A total of 351 patients were analyzed. Catheter survival at 12 months was similar between Group A and Group B (84.0% vs. 86.8%, p = 0.45), with no difference in long-term survival (log-rank p = 0.32). Catheter failure rates were comparable (6.5% vs. 6.0%, p = 0.86). Non-surgical interventions for catheter dysfunction occurred in 8.9% of Group A and 8.8% of Group B (p = 0.97), with a success rate of 83.9%. Omental wrapping occurred only in Group A (7.1%) but did not affect overall outcomes. Early and late complications, including peritonitis and obstruction, were similar between groups. Operative time was significantly shorter without omentectomy (45.2 ± 9.1 vs. 66.3 ± 10.8 min, p < 0.001), while hospital stay was comparable.

CONCLUSION

Routine omentectomy does not improve catheter outcomes but increases operative time. A selective approach may be sufficient in pediatric PD catheter placement.