There is still controversy as to whether PD-treatment can be safely continued after herniotomy (HT). Many nephrologists withhold PD-treatment for several weeks after HT in fear of dialysate leakage and/or hernia recurrence. We report on 12 patients (2 women, 10 men) in whom HT was performed either for umbilical (n = 6), inguinal (n = 6) or open processus vaginalis (n = 3). Surgery was performed according to the Lichtenstein method with insertion of a Marlex-mesh and ligation of the hernia sac. In all patients PD treatment was paused for the day of surgery and 1 to 3 days postoperatively, depending on RRF. Low volume (1.0 to 1.5 l) and high frequency exchanges (6 exchanges per day) were started for several days with a gradual reinstitution of the former PD-regimen within the next 2 to 4 weeks. All patients did well rapidly with no uraemia-or dialysis-related complications. No leakage and no hernia recurrence could be observed 3 months thereafter. None of the patients had to be haemodialysed intercurrently. In conclusion, continuing a modified regimen of PD-treatment after HT seems to be safe and comfortable for the patient.
CaseA 68-year-old man with diabetes and chronic kidney disease stage 5 was referred to start peritoneal dialysis (PD). A PD catheter was placed surgically. After starting PD, dialysate leaked from the exit site occasionally resulting in a wet dressing. The physical examination and repeated tunnel ultrasound examinations showed no fluid around the catheter. A contrast imaging of the catheter lumen, performed by infusing ionized contrast media into the PD catheter lumen followed by dialysate, was not indicative of a catheter leakage (Fig. 1A). Because there was an ongoing, intermittent fluid loss with wet dressings, a clamp was placed on the catheter lumen near the catheter exit, and intraabdominal pressure was increased by pressing on the abdominal wall. This maneuver resulted in a ''waterfall'' (Fig. 1B) of dialysate out of the catheter exit site. Questions(1) Where is the cause of the dialysate leakage?(2) Why is the contrast imaging of the PD catheter lumen unremarkable? Answers(1) The increased pressure (clamps near the catheter exit and manual abdominal wall compression) uncovered a small catheter leak under the skin, in the first part of the tunnel. On the explanted PD catheter, a small cleft was found as shown in Fig. 1C.(2) The difficulty in finding the catheter leak was explained by the ventil (or flap-like) character of the small cleft in the proximal tunnel part of
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