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SAGES peritoneal dialysis access guideline update 2023

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

AL:

Advanced laparoscopic technique

BL:

Basic laparoscopic technique

CAPD:

Continuous ambulatory peritoneal dialysis

CI:

Confidence interval

CKD:

Chronic kidney disease

ESRD:

End stage renal disease

EtD:

Evidence to decision

GRADE:

Grading of Recommendations, Assessment, Development, and Evaluation

HD:

Hemodialysis

HPD:

Concomitant hernia repair and peritoneal dialysis access

IR:

Interventional radiology

ISPD:

International Society for Peritoneal Dialysis

KQ:

Key question

OR:

Odds ratio

PD:

Peritoneal dialysis

PICO:

Population, intervention, comparator, outcome

RCT:

Randomized controlled trial

RRT:

Renal replacement therapy

RIGHT:

Essential Reporting Items for Practice Guidelines in Healthcare

SAGES:

The Society of American Gastrointestinal and Endoscopic Surgeons

US:

United States of America

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Acknowledgements

The authors would like to thank Sarah Colón, the SAGES senior program coordinator, and Holly Burt, the SAGES librarian, for their contributions to this project.

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Authors and Affiliations

  1. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA

    Stephen P. Haggerty

  2. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Sunjay S. Kumar

  3. Department of Surgery, Hiram C. Polk, Jr., University of Louisville, Louisville, KY, USA

    Amelia T. Collings

  4. Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, USA

    Vamsi V. Alli

  5. Department of Surgery, UCSF East Bay, University of California, San Francisco, CA, USA

    Emily Miraflor

  6. Department of Surgery, Queen’s University, Kingston, ON, Canada

    Nader M. Hanna

  7. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Dimitrios I. Athanasiadis & Dimitrios Stefanidis

  8. Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    David J. Morrell

  9. Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Mohammed T. Ansari

  10. Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada

    Ahmed Abou-Setta

  11. Department of Surgery, University of Kentucky, Lexington, KY, USA

    Danielle Walsh

  12. Department of Surgery, University of Chicago Medicine, Chicago, IL, USA

    Bethany J. Slater

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  1. Stephen P. Haggerty
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Corresponding author

Correspondence to Stephen P. Haggerty.

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Disclosures

Stephen P. Haggerty has received consulting fees and speaking fees from Medtronic Renal Division for development of their educational content. Danielle Walsh holds leadership positions with SAGES and the American College of Surgeons and has received travel reimbursement fees from both organizations. Dimitrios Stefanidis has received research grants from Intuitive Surgical and Beckton Dickinson and consulting fees from Applied Medical and Johnson & Johnson. He holds leadership roles with SAGES, the Association for Surgical Education, and the American Society for Metabolic and Bariatric Surgery. Bethany J. Slater has received consulting fees from Hologic and Cook Medical. Sunjay S. Kumar, Amelia T. Collings, Vamsi V. Alli, Emily Miraflor, Nader M. Hanna, Dimitrios I. Athanasiadis, David J. Morrell, Mohammed T. Ansari, and Ahmed Abou-Setta have no relevant financial ties to disclose.

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Haggerty, S.P., Kumar, S.S., Collings, A.T. et al. SAGES peritoneal dialysis access guideline update 2023. Surg Endosc 38, 1–23 (2024). https://doi.org/10.1007/s00464-023-10550-8

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