The purpose of this study was to determine the impact of omentectomy on peritoneal dialysis catheter failure rates in pediatric patients with renal failure. A retrospective review of children undergoing peritoneal catheter placement was performed over a 22-year period. Children were segregated into those undergoing catheter placements with omentectomy or without. One hundred sixty-three patients were reviewed, with a 1:1.03 ratio of male to female patients. The mean age was 6.25 ± 5.58 years. Fifty-three percent underwent omentectomy. Catheter failure was observed in 63 children (39%). Catheter obstruction was identified in 36%. Peritonitis led to failure in 9.8%. Catheter failure rate was significantly reduced with the performance of omentectomy (23% without omentectomy vs 15% with omentectomy, P = .0054). Differences in time to catheter failure did not reach statistical significance in the omentectomy group (759 vs 280 days, P = .13). Omentectomy conferred improved utility of peritoneal catheters in children. Omentectomy appears useful in children undergoing peritoneal dialysis catheter placement.