Purpose <p>Peritoneal dialysis has been demonstrated to be a cost-effective modality of dialysis treatment, providing a greater quality of life in comparison to hemodialysis. However, complications associated with the peritoneal dialysis catheter (PD catheter) can lead to increased patient morbidity and thus the necessity of PD catheter removal. While prior studies have identified patient-related risk factors, the impact of various surgical risk factors on technical survival is yet to be elucidated.</p> Methods <p>A retrospective, monocentric cohort study was conducted including all patients who underwent PD catheter implantation through an open surgical technique utilizing a small surgical incision above the rectus abdominis muscle from January 2010 to March 2022. The technical survival of PD catheters was observed retrospectively over a period of three years and the reasons for PD catheter removal were summarized. Furthermore, Cox regression analysis was conducted to evaluate potential risk factors for a reduced technical survival.</p> Results <p>A total of 340 patients were included, and a median PD catheter functionality of 980 days was presented in this study. The main reasons for PD catheter removal included infectious complications and mechanical malfunctions. Postoperative revision was identified as a significant risk factor for a reduced technical survival.</p> Conclusion <p>PD catheter implantation through a small surgical incision showed a high long-term functionality regardless of prior abdominal surgery, prior PD catheter implantation, or the necessity of adhesiolysis. Only postoperative revision was identified as a significant risk factor for PD catheter removal.</p> Trial registration <p>The study was registered in the German clinical trial database (Application number DRKS00036575, registration date 19.05.2025).</p> Graphical abstract <p></p>