Clinical benefits of routine examination and synchronous repair of occult inguinal hernia during laparoscopic peritoneal dialysis catheter insertion: a single-center experience

Abstract

Purpose Occult inguinal hernias (IH) predispose peritoneal dialysis (PD) patients to the symptomatic IH formation after starting PD, which may cause complications. We conducted a retrospective study to assess the benefit/risk profile of routine laparoscopic examination for occult IH (RLEOH) with a synchronous repair in patients receiving PD catheter placement. Methods 432 patients were enrolled in this study. Patients with an internal hernia sac at all sizes were deemed to have occult IH. We retrospectively reviewed data including demographic characteristics and operative details. We also measured incidence rates of symptomatic IH, metachronous IH repair, and catheter survival over a follow-up period after starting PD. Results These patients were classified into the RLEOH group (n = 365) and the non-RLEOH group (n = 67). The RLEOH group was subdivided into occult IH with a synchronous repair (n = 17; the subgroup A), no occult IH (n = 339; the subgroup B), and occult IH without a synchronous repair (n = 9; the subgroup C). The incidence rates of symptomatic IH developed after staring PD in subgroups A, B, and C were 0, 5.6, and 22.2%, respectively, whereas that in the non-RLEOH group was 13.4%. The RLEOH group had a reduced hazard ratio for metachronous IH repair compared with the non-RLEOH group (HR = 0.426; 95% CI 0.195–0.930, p = 0.032). None of our patients suffered from herniorrhaphy-related complications. Conclusion RLEOH with a synchronous repair during PD catheter insertion confers clinical benefits in reducing the risk of developing IH after starting PD and the need for a metachronous repair. This is a safe and reasonable approach.

Modified minimally invasive laparoscopic peritoneal dialysis catheter insertion with internal fixation

“…The incidence of catheter dysfunction was 31.8% with open surgery, 17.5% with basic laparoscopy, and only 4.4% with advanced laparoscopy [ 11 ]. For patients with cholecystitis and occult hernia, cholecystectomy and hernia repair can be performed during advanced laparoscopic PDC insertion to avoid postoperative infectious complications and hernia, which takes full advantage of laparoscopic procedure [ 12 , 13 ]. Different surgeons tend to set different numbers of laparoscopic ports.…”

Immediate Dialysis After Simultaneous Laparoscopic Peritoneal Dialysis Catheter Placement and Laparoscopic Inguinal Hernia Repair

“…A study on managing open inguinal repair and PDC placement has been conducted. 10,21 Kou et al reported diagnosis of inguinal hernia using laparoscopic approach with open inguinal hernia repair. 10 However, in our study, laparoscopic PDC placement and laparoscopic inguinal hernia repair was performed utilizing a 1-cm incision and three incisions of 5-mm size.…”

“…10,21 Kou et al reported diagnosis of inguinal hernia using laparoscopic approach with open inguinal hernia repair. 10 However, in our study, laparoscopic PDC placement and laparoscopic inguinal hernia repair was performed utilizing a 1-cm incision and three incisions of 5-mm size. This eliminates two admissions and operations and reduces cost and risk of anesthesia.…”

“…2,[7][8][9] Regular daily PD in patients with ESRD with a weak abdominal wall increases intra-abdominal pressure, which may contribute to the formation of new hernia and may provide insight regarding occult hernia. 1,10 Indeed, the occurrence of inguinal hernia in PD may lead to complications such as hernia obstruction, strangulation, hydrocele bowel obstruction, and dialysate leakage. 1,2,11 Hence, surgeons should examine patients for hernia and repair them before initiating PD.…”

“…3,12 Laparoscopic identification of occult inguinal hernia with simultaneous open inguinal hernia repair reported promising outcome. 10 Thus, we reported the first simultaneous laparoscopic placement of PDC and laparoscopic inguinal hernia repair with immediate use of PD.…”