Background: Peritoneal dialysis (PD) is the first-line renal replacement therapy for end-stage renal failure patients in Hong Kong. Abdominal wall hernia is a common mechanical complication of PD, and early surgical repair has been advocated to reduce complications. This study aims to review the outcomes of tension-free mesh repair of inguinal hernia in PD patients. Methods: All PD patients who underwent elective repair of inguinal hernia from 2009 to 2015 were identified from a single centre for retrospective analysis. Primary outcomes included surgical complications, perioperative dialysis technique and recurrence. Results: Twenty-one patients with a total of 26 inguinal hernia repairs were included in this 7-year retrospective study. All were males, and the mean age was 68 ± 10 years. Diabetic nephropathy ( n = 9, 42.9%) and glomerulonephritis ( n = 7, 33.3%) were the two most common causes of renal failure. All hernias were detected after the initiation of PD, and the mean duration of PD to hernia detection was 16 months (range 1–65 months). Lichtenstein open mesh repair was performed in all patients. Complications included seroma ( n = 3, 11.5%) and ischaemic orchitis ( n = 1, 3.8%). There were no mesh infection or recurrence. Twenty patients (95.2%) received intermittent peritoneal dialysis post-operatively and returned to continuous ambulatory PD in 15 to 30 days. Only one patient (4.8%) required bridging haemodialysis due to Tenckhoff catheter blockage. Conclusions: Tension-free mesh repair is associated with low morbidity and low recurrence rates in PD patients. Timely management and close collaboration with renal physicians are essential to continue PD after repair.
Figure 1 An 83−year−old woman with a known history of hiatus hernia was admitted to our unit complaining of retrosternal discomfort and repeated vomiting. A chest radiograph on admission revealed a distended precordial gas− tric bubble, suggestive of intrathoracic gastric herniation. Initial upper endoscopy revealed bi− zarre gastric anatomy and it was not possible to negotiate the pyloric channel. Barium meal (a) and computed tomography (b) confirmed the diagnosis of paraesophageal hernia with intra− thoracic upside−down stomach. Figure 3 The lower part of the stomach was negotiated easily after the endoscopic reduc− tion, and these post−reduction views show the twisted stomach (white arrow) and the parae− sophageal hernia (black arrow) (a), and the twisted stomach (b). Elective laparoscopic hia− tal closure and gastropexy was performed 3 days later. Figure 2 Upper endoscopy was repeated and, using a J−type maneuver, the organoaxial volvu− lus was successfully derotated in an anticlock− wise direction (arrow).
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Clinicians were generally receptive of the concept of the AD, willing to practice it clinically, and supported its legal recognition. However, AD discussions were an infrequent encounter, hence many clinicians lack experience and are unfamiliar with relevant guidelines. Large-scale studies within the health care professions as well as qualitative studies further exploring potential barriers should follow.
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