Prosthetic Mesh Repair of Multiple Recurrent and Large Abdominal Hernias in Continuous Ambulatory Peritoneal Dialysis Patients

Abstract

Objective The aim of this study was to find out whether prosthetic mesh repair of recurrent and large abdominal hernias in continuous ambulatory peritoneal dialysis (CAPD) patients is effective in maintaining them on CAPD. Design Retrospective analysis of case notes over a period of 5 years. Setting Single renal unit of a university hospital. Patients Forty-six of 217 CAPD patients (16%) had their hernias repaired. Among them, 5 women in whom hemodialysis was not possible had multiple or large hernias repaired with polypropylene (PP) mesh. Results Radical repair was achieved by a modified operation consisting of a conventional hernioplasty complemented by a supporting prosthetic overlay mesh, without discontinuation of CAPD. The patients continued CAPD for a mean period of 17.6 months without hernia recurrence. Two patients died in the twelfth and fifteenth postoperative month due to cardiac arrest and hepatic failure, respectively, and the remaining 3 are alive and have been doing well on CAPD for 13, 14, and 21 months. Conclusions Prosthetic mesh repair of large recurrent hernias in CAPD patients with vascular access problems seems to be a valuable method to maintain them on this renal replacement therapy.

Continuing CAPD after herniotomy

“…Although CAPD was re-instituted as soon as 1 to 3 days after surgery, none of our patients experienced early or late leakage or a hernia recurrence, irrespective of the localisation of the hernia. This is in accordance with excellent results reported in the literature (9). Failure of this surgical technique for hernia repair is rare although it has been reported in the literature (10).…”

Incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis patient

“…A large volume of dialysate is prescribed to improve the peritoneal small molecule clearance in order to make the clinical target level adequate [1]. Hernia has been found to be more prevalent among peritoneal dialysis patients than in the general population, with its reported frequencies of 10% to 25% and with an incidence of 0.06 hernias per dialysis year [3,[6][7][8]. A few studies have reported that pre-existing hernias were detected in 5.5% to 12.3% of peritoneal dialysis patients before CAPD was initiated on the patient [1,3,9].…”

“…The traditional operation method for abdominal wall hernia repair in peritoneal dialysis patients requires discontinuing the peritoneal dialysis for a long period of days to weeks after the operation to prevent damage of the repair site [12]. Polypropylene mesh repair was recently used for hernias of patients on CAPD [3,7,13]. Low-tension mesh repair provides a technically simple solution to the many surgical disadvantages of CAPD patients [13].…”

“…Mesh hernia repair failure is generally rare and involved in unusual co-morbidity [14]. Prosthetic mesh repair of hernias in CAPD patients with vascular access problems seems to be useful for keeping such patients on this renal replacement therapy [7]. Most hernias are asymptomatic.…”

Do Abdominal Hernias in Peritoneal Dialysis Patients Require Repair?

“…Abdominal hernias are not as common as they were 15–20 years ago when peritoneal dialysis (PD) catheters were placed in the midline (1). These and inguinal hernias, however, are still seen in 2%–15% of PD patients (2–5).…”