Abstract：
Minimally invasive surgery has been used for both de novo insertion and salvage of peritoneal dialysis (PD) catheters. Advanced laparoscopic, basic laparoscopic, open, and image-guided techniques have evolved as the most popular techniques. The aim of this guideline was to develop evidence-based guidelines that support surgeons, patients, and other physicians in decisions on minimally invasive peritoneal dialysis access and the salvage of malfunctioning catheters in both adults and children.
A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons reviewed the literature since the prior guideline was published in 2014 and developed seven key questions in adults and four in children. After a systematic review of the literature, by the panel, evidence-based recommendations were formulated using the Grading of Recommendations Assessment, Development and Evaluation approach. Recommendations for future research were also proposed.
After systematic review, data extraction, and evidence to decision meetings, the panel agreed on twelve recommendations for the peri-operative performance of laparoscopic peritoneal dialysis access surgery and management of catheter dysfunction.
In the adult population, conditional recommendations were made in favor of: staged hernia repair followed by PD catheter insertion over simultaneous and traditional start over urgent start of PD when medically possible. Furthermore, the panel suggested advanced laparoscopic insertion techniques rather than basic laparoscopic techniques or open insertion. Conditional recommendations were made for either advanced laparoscopic or image-guided percutaneous insertion and for either nonoperative or operative salvage. A recommendation could not be made regarding concomitant clean-contaminated surgery in adults. In the pediatric population, conditional recommendations were made for either traditional or urgent start of PD, concomitant clean or clean-contaminated surgery and PD catheter placement rather than staged, and advanced laparoscopic placement rather than basic or open insertion.
A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons reviewed the literature since the prior guideline was published in 2014 and developed seven key questions in adults and four in children. After a systematic review of the literature, by the panel, evidence-based recommendations were formulated using the Grading of Recommendations Assessment, Development and Evaluation approach. Recommendations for future research were also proposed.
After systematic review, data extraction, and evidence to decision meetings, the panel agreed on twelve recommendations for the peri-operative performance of laparoscopic peritoneal dialysis access surgery and management of catheter dysfunction.
In the adult population, conditional recommendations were made in favor of: staged hernia repair followed by PD catheter insertion over simultaneous and traditional start over urgent start of PD when medically possible. Furthermore, the panel suggested advanced laparoscopic insertion techniques rather than basic laparoscopic techniques or open insertion. Conditional recommendations were made for either advanced laparoscopic or image-guided percutaneous insertion and for either nonoperative or operative salvage. A recommendation could not be made regarding concomitant clean-contaminated surgery in adults. In the pediatric population, conditional recommendations were made for either traditional or urgent start of PD, concomitant clean or clean-contaminated surgery and PD catheter placement rather than staged, and advanced laparoscopic placement rather than basic or open insertion.
摘要：
背景：微创手术已用于腹膜透析（PD）导管的从头插入和抢救。先进的腹腔镜，基本腹腔镜，打开,和图像引导技术已经发展成为最受欢迎的技术。本指南的目的是制定支持外科医生的循证指南，病人,和其他医生决定对成人和儿童进行微创腹膜透析和挽救故障导管。
方法：美国胃肠和内窥镜外科医师协会的一个指南委员会小组回顾了自2014年之前的指南发布以来的文献，并在成人中提出了七个关键问题，在儿童中提出了四个关键问题。在对文献进行系统回顾之后，由小组，基于证据的建议是使用建议分级评估制定的，开发和评估方法。还提出了未来研究的建议。
结果：经过系统评价，数据提取,和决定会议的证据，专家组就腹腔镜腹膜透析入路手术的围手术期表现和导管功能障碍的处理提出了12项建议.
结论：在成年人口中，有条件的建议是:在医学上可能的情况下,分阶段疝修补后再插入PD导管,而不是同时开始,传统开始,而不是紧急开始。此外，小组建议采用先进的腹腔镜插入技术，而不是基本的腹腔镜技术或开放式插入。对高级腹腔镜或图像引导经皮插入以及非手术或手术抢救提出了有条件的建议。不能就成人伴随的清洁污染手术提出建议。在儿科人群中，对PD的传统或紧急启动提出了有条件的建议，同时进行清洁或清洁污染的手术和PD导管放置，而不是分阶段进行，和先进的腹腔镜放置，而不是基本或开放插入。
方法：美国胃肠和内窥镜外科医师协会的一个指南委员会小组回顾了自2014年之前的指南发布以来的文献，并在成人中提出了七个关键问题，在儿童中提出了四个关键问题。在对文献进行系统回顾之后，由小组，基于证据的建议是使用建议分级评估制定的，开发和评估方法。还提出了未来研究的建议。
结果：经过系统评价，数据提取,和决定会议的证据，专家组就腹腔镜腹膜透析入路手术的围手术期表现和导管功能障碍的处理提出了12项建议.
结论：在成年人口中，有条件的建议是:在医学上可能的情况下,分阶段疝修补后再插入PD导管,而不是同时开始,传统开始,而不是紧急开始。此外，小组建议采用先进的腹腔镜插入技术，而不是基本的腹腔镜技术或开放式插入。对高级腹腔镜或图像引导经皮插入以及非手术或手术抢救提出了有条件的建议。不能就成人伴随的清洁污染手术提出建议。在儿科人群中，对PD的传统或紧急启动提出了有条件的建议，同时进行清洁或清洁污染的手术和PD导管放置，而不是分阶段进行，和先进的腹腔镜放置，而不是基本或开放插入。
