Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension-free mesh repair feasible?

Abstract

Background Continuous ambulatory peritoneal dialysis (CAPD), which often causes a common complication such as abdominal wall hernia, is a prevalent alternative therapy for end-stage renal failure patients. However, relevant studies are somewhat rare, and the peritoneal dialysis (PD) protocol during the perioperative period is still controversial. The aim of this study was to evaluate the effectiveness and perioperative management of tension-free mesh repair for inguinal hernias in CAPD patients. Methods Between January 2013 and December 2019, 18 CAPD patients with 20 inguinal hernias who underwent tension-free mesh repair were retrospectively analyzed. Data on demographics, perioperative features, the perioperative dialysis protocol and surgical complications were collected and assessed. Results All hernias were diagnosed after the start of CAPD, and the median duration from PD onset to hernia formation was 16 months (2–61 months). All patients underwent successful tension-free mesh repair, including 17 Lichtenstein and 3 anterior Kugel procedures. The median operation time was 62.5 min, and the median postoperative hospital stay was 3 days. Fifteen patients received low-exchange volumes and high-frequency exchanges from 1 to 3 days after surgery for 2 weeks with gradual resumption of the original CAPD regimen within 4 weeks. Complications included seroma (n = 2) and hematoma (n = 1). No wound or mesh infection or recurrence occurred during the follow-up period. Conclusions Tension-free mesh repair is safe and feasible for inguinal hernias in CAPD patients, The Lichtenstein mesh repair should be the first choice, and anterior Kugel repair may be considered an effective procedure. Bridging hemodialysis seems unnecessary except for emergency surgery.

Complications of Peritoneal Dialysis Part I

“…Most patients are able to resume PD on postoperative day 3. 31 However, the patient who is anuric or has incarcerated or strangulated bowel as a consequence of the hernia would be better served with a temporary transition to hemodialysis. Many factors are considered for the PD prescription after surgical hernia repair, such as residual kidney function, patient body habitus, and potential surgical complications.…”

Epidemiology, risk factors and recurrence of inguinal umbilical, and incisional hernias in patients under peritoneal dialysis: literature review

“…En otra serie pequeña retrospectiva publicada por Chi y cols. se recomienda como primera opción la técnica de Lichtenstein y la reparación anterior de Kugel 43 . La técnica de McVay es la reportada en el estudio retrospectivo de Jung y cols.…”

“…Chi y cols. especifican el abordaje mediante anestesia general en la mayoría de los procedimientos e indican la local solo cuando la general o la locorregional estuvieran contraindicadas, aunque explican que el régimen seguido se hacía según el criterio del anestesista 43 . Smietanski aconseja el uso de técnicas de reparación libres de tensión con anestesia local o epidural 17 .…”

“…Shah observó con una de estas medidas una gran cantidad de recidivas tardías durante el periodo de seguimiento, aunque no necesariamente se atribuyó al comienzo anticipado de la diálisis peritoneal en condiciones de baja presión abdominal 53 . Sin embargo, otros autores no reflejan este resultado realizando el mismo procedimiento 54,55 ; de hecho, la mayoría de los reportes no observan recurrencias herniarias durante el periodo de seguimiento ni fugas importantes 15,24,43 al reinstaurar precozmente la diálisis peritoneal, aunque sí se encuentren descritas en la literatura 53,56 . Se informa también en algunos artículos del inicio de la diálisis peritoneal dentro de las 24 horas posoperatorias con buenas recuperaciones 30,39,41,52 .…”