Perioperative Management of Peritoneal Dialysis Patients Undergoing Hernia Surgery without the use of Interim Hemodialysis

Abstract

Objective To review the feasibility of undertaking elective hernia repair in peritoneal dialysis (PD) patients without converting them to hemodialysis. Design A 10-year retrospective review of prospectively collected data. Setting PD unit of a university-based hospital. Patients and Methods All patients received regular exchanges until the morning of the surgery and remained off dialysis for the first 48 hours postoperatively. After that, PD was gradually reintroduced. The patients on continuous ambulatory PD (CAPD) received intermittent PD (IPD) 3 times per week for 10 hours per day for 2 weeks, followed by 5 exchanges of low volume (1 – 1.5 L) CAPD for 2 weeks, returning to the pre-surgery prescription by 4 weeks. Patients on continuous cycling PD (CCPD) received 1 week of IPD followed by 4 weeks of nocturnal IPD and returned to the original dose in 5 weeks. Between 1 April 1995 and 31 March 2005, 50 consecutive patients were managed by this protocol. Average age was 65 years and 67.7% were males. The original disease was diabetes mellitus (19 patients), hypertension ( 6 ), chronic glomerulonephritis (13), polycystic kidney disease ( 6 ), and others ( 6 ). The types of abdominal hernias included umbilical (25 patients), inguinal (18), incisional ( 5 ), and epigastric ( 2 ). 42 patients were on CAPD and 8 on CCPD. Average duration of PD prior to development of hernia was 16.4 months. Results Average pre-surgery creatinine was 673 μmol/L, increasing to 968 μmol/L on IPD. Serum potassium increased from 3.4 to 4.7 mmol/L. No episodes of hyperkalemia were noted. The average total follow-up was 33.4 months. None of the patients had leakage or early hernia recurrence due to early resumption of PD; 13 patients had recurrence of the same hernia after a median 19.9 months; 4 patients had hernias at different sites after an average of 55 months. Conclusions Based on this experience, we recommend that PD patients undergoing elective abdominal hernia surgery should continue PD according to the prescribed protocol. Interim hemodialytic support does not appear to be necessary in most patients.

Which clinical conditions are most suitable for induction of automated peritoneal dialysis?

“…In fact, there have been several reports showing that APD had a lower rate of herniation than CAPD [41,44], although other reports have shown no significant difference in the incidence of herniation with APD versus CAPD [48] (Table 4). However, the latter reports compared dwell volumes of more than 2 L. Therefore, it may be useful to maintain only up to approximately 1 L to prevent an increase in abdominal pressure and to decrease the risk of peritoneal leakage and herniation in high-risk patients [49,50]. A Japanese report showed that intra-abdominal pressure was not significantly increased when dwell volume was less than 1 L in Japanese patients [51].…”

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

“…There is no consensus on whether it is necessary to convert to HD or on the time needed to resume CAPD after surgery [4,6,9,10,16,23]. One investigation revealed that some centers in the UK received temporary HD postoperatively and that the median duration of resuming CAPD was 4 weeks (1 day − 8 weeks)[23].…”

“…Continuous ambulatory peritoneal dialysis (CAPD) is a prevalent and acceptable alternative therapy for patients with end-stage renal failure (ESRL) and has many economic bene ts, is convenient, avoids the pain of establishing the vascular access needed for hemodialysis (HD) and provides a survival advantage while retaining residual renal function (RRF) [1][2][3]. Abdominal wall hernia is an unavoidable noninfectious complication in CAPD patients that is considered to be caused by the sustained increase in intra-abdominal pressure caused by injecting a large amount of dialysate during CAPD and by deterioration of abdominal wall tissue at this stage [4,5]. The main types of hernias in CAPD patients include inguinal, umbilical, incisional and epigastric, and the former two types are the most common [4,6].…”

Peritonealdialyse

“…Die PD kann mit niedrigeren Füllvolumen oder mittels Cyclertherapie (IPD) innerhalb von 72 Stunden postoperativ gestartet werden. Eine Überbrückung mittels Hämodialyse ist nicht erforderlich [8,9]. Bei einer intraperitonealen Netzapplikation erfolgt die Neoepithelialisierung nach 2 Wochen und ist nach einem Monat komplett ausgebildet [10].…”