Tension-free mesh repair of inguinal hernia in patients on continuous ambulatory peritoneal dialysis

Abstract

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.

Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension-free mesh repair feasible?

“…In addition, due to the frequent infusion of peritoneal dialysis and the presence of prostheses as foreign bodies, infectious complications are likely to occur, particularly if the sterile technique needed for hernioplasty is not strict enough. We did not observe any wound or mesh infection in our group of patients after treatment with antibiotic prophylaxis, which was consistent with the ndings of other studies [6,9]. Although there were two patients in our study who developed bacterial peritonitis 2 and 3 months after hernioplasty, considering the time interval between surgery and infection, we believe that the infection was not related to surgery, as observed in the other studies [6,10]; moreover, both patients were cured after intraperitoneal antibiotic treatment without removal of the peritoneal catheter or interruption of CAPD.…”

“…In this study, we found no recurrences after tension-free mesh repair for inguinal hernia, including those patients who had early resumption of CAPD after repair, which demonstrates that tension-free mesh hernioplasty for CAPD patients is safe and feasible, which is consistent with the ndings of other studies [5,6,9,10]. Luk et al [6] demonstrated that the Lichtenstein mesh repair remains the gold standard for patients with CAPD. Gianetta et al [10] also claimed that the results of the Lichtenstein technique under local anesthesia for these high-risk subgroups are satisfactory.…”

“…Inguinal hernias in CAPD patients may cause local groin pain, swelling of the groin or genitals, ultra ltration failure, and even bowel strangulation; however, similar to common hernia symptoms, most hernias in CAPD patients are asymptomatic, which might make them di cult to discover by nephrologists. Current modalities commonly used in studies to identify hernias in these patients include ultrasound, CT, peritoneal scintigraphy and CT peritoneography, and the latter modality is considered the reference standard for diagnosis [6,7,15]. Although it has a high detection rate and widespread availability, this modality has limitations; the process requires a strictly sterile technique, and patients need to be exposed to ionizing radiation [7].…”

“…There is no consensus on whether it is necessary to convert to HD or on the time needed to resume CAPD after surgery [4,6,9,10,16,23]. One investigation revealed that some centers in the UK received temporary HD postoperatively and that the median duration of resuming CAPD was 4 weeks (1 day − 8 weeks)[23].…”

“…One investigation revealed that some centers in the UK received temporary HD postoperatively and that the median duration of resuming CAPD was 4 weeks (1 day − 8 weeks)[23]. In contrast, some studies advocated the conversion to intermittent PD for 2-4 weeks after surgery before restoring the preoperative CAPD regimen [6,24]. Other studies have promoted postoperative PD schemes in which patients receive low-volume and high-frequency exchanges with a gradual regain of the preoperative CAPD regimen in 2-4 weeks [9,16].…”