Ambulatory Peritoneal Dialysis and Hernial Complications

Spigelian hernia occurs through slit like defect in the anterior abdominal wall adjacent to the semilunar line. Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. The hernia ring is a well-defined defect in the transverses aponeurosis. The hernial sac, surrounded by extraperitoneal fatty tissue, is often interparietal passing through the transversus and the internal oblique aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique. Spigelian hernia is in itself very rare and more over it is difficult to diagnose clinically. It has been estimated that it constitutes 0.12% of abdominal wall hernias. The spigelian hernia has been repaired by both conventional and laparoscopic approach. Laparoscopic management of spigelian hernia is well established. Most of the authors have managed it by transperitoneal approach either by placing the mesh in intraperitoneal position or by raising the peritoneal flap and placing the mesh in extraperitoneal space. There have also been case reports of management of spigelian hernia by total extraperitoneal approach. We retrospectively reviewed our experience of ten patients between 1997 and 2007. Eight patients (8/10) presented with abdominal pain and two patients (2/10) were asymptomatic. In six patients (6/10) we performed an intraperitoneal onlay IPOM repair, in two patients (2/10) transabdominal preperitoneal repair (TAPP), and in two (2/10) total extraperitoneal repair (TEP). There were no recurrences, or other morbidity at mean follow up period of 3.2 years (range 6 months to 10 years).

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“…Spigelian hernia has been described as a complication of chronic ambulatory peritoneal dialysis (CAPD). [11]…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of Spigelian hernia: A review of literature and our experience

et al. 2008

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“…Hernias are common in CAPD patients because of anatomic, hydrostatic, and metabolic factors. 18,19 The greater the fluid volume instilled, the greater the pressure and the higher the incidence of hernias. 20 Therefore, diagnosis and repair of existing hernias before instituting CAPD is essential.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy to Evaluate Scrotal Edema During Peritoneal Dialysis

Jorge

2013

JSLS

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“…Case 2 and other reports [2] show that diagnosis by conventional herniography is not always possible. Furthermore, as demonstrated by case 1, even if a hernia sac is present, it need not be the cause of genital edema [3], It is essential, therefore, to define the exact cause of genital edema in CAPD patients prior to under taking surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Although frequently caused by inguinal hernias, other sites of peritoneal fluid leak have been recognized [6,8], When an inguinal hernia has only a small opening and is devoid of visceral herniation, the characteristic cough impulse may be absent, so that mak ing the diagnosis by physical examination alone is diffi cult [3], Even when a hernia is present in a CAPD patient with genital edema, it does not necessarily indicate a cause-effect relationship, since hernias are so common in these patients [3], A hernia repair, therefore, may not lead to elimination of the edema. We describe 3 CAPD patients with genital edema who illustrate the complexity of the problem.…”

Section: Introductionmentioning

confidence: 99%

Genital Edema in Patients on Continuous Ambulatory Peritoneal Dialysis

Singal¹,

Segel²,

Bruns³

et al. 1986

Am J Nephrol

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Severe genital edema is a well-described complication of continuous ambulatory peritoneal dialysis (CAPD). Leakage of dialysate fluid from defects in the peritoneum may occur from clinically detectable and undetectable inguinal hernias, defects at the catheter insertion site, or other defects in the peritoneal membrane. We describe 3 patients (who underwent five surgical procedures), illustrating the complexity of the problem. In 2 patients, unsuccessful surgical repairs (1 catheter replacement, 1 hernia repair) were performed based on misleading radiologic findings using intraperitoneal contrast without computerized tomography (CT) scanning. The use of CT scanning with intraperitoneal contrast led to the correct diagnosis and prompt surgical correction in both patients so studied. One patient had leakage from a clinically undetectable inguinal hernia, and the other had a peritoneal defect at the Tenckhoff insertion site which was only demonstrated following a period of upright posture with a 3-liter exchange. Our experience and a review of the literature convinces us that a CT scan of the abdomen utilizing radiocontrast material added to the dialysate accurately identifies the site of leakage in CAPD patients who develop genital edema. Thus, the CT scan can help avoid unnecessary surgery and prolonged hospitalization in CAPD patients who develop genital edema.

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Ambulatory Peritoneal Dialysis and Hernial Complications

Cited by 59 publications

References 15 publications

Diagnosis and management of Spigelian hernia: A review of literature and our experience

Diagnosis and management of Spigelian hernia: A review of literature and our experience

Laparoscopy to Evaluate Scrotal Edema During Peritoneal Dialysis

Genital Edema in Patients on Continuous Ambulatory Peritoneal Dialysis

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