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PREVALENCE AND MANAGEMENT OF HERNIAS IN PERITONEAL DIALYSIS PATIENTS

Department of Surgery,¹ Puerta del Mar University Hospital; Department of Nephrology² and Department of Surgery,³ Puerto Real University Hospital, University of Cádiz, Spain

Correspondence to: M.Á. García-Ureña, Avda de la Salinera 26, 11500 El Puerto de Santa María, Spain.
mgarciau{at}meditex.es

• Objectives: The aim of this study was to assess the prevalence of hernias before and after the start of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal disease, and to evaluate the result of a proposed surgical treatment.
  
• Design: Prospective observational study.
  
• Setting: University hospital.
  
• Patients: 122 patients who started CAPD from 1994 to 2000; 26 hernias were diagnosed in 21 (17.2%) patients.
  
• Main Outcome Measures: Finding of hernias; morbidity associated with catheter insertion and hernia repair; recurrence of hernias.
  
• Results: 19 hernias were detected in 15 patients (12.3%) before they began CAPD; only 7 hernias were observed while on CAPD. Umbilical (61.5%) and inguinal (26.9%) hernias were the most common. Multiple hernias were detected in 4 patients. Simultaneous repair of hernia and catheter insertion was performed in patients with preexisting hernias. Under local anesthesia, most patients were operated on with surgical techniques of tension-free hernioplasty using a polypropylene mesh. Only mild postoperative complications were recorded: 3 seromas and 1 hematoma. No fluid leakage was found in our series. There were no long-term complications (infection or recurrence) related to the mesh.
  
• Conclusions: 73% of hernias in peritoneal dialysis patients occur before starting dialysis. Hernia problems in these high-risk patients can be safely solved using a careful technique with application of tension-free hernioplasty. Most may be repaired under local anesthesia with simultaneous catheter insertion.
  

KEY WORDS: Hernia; inguinal hernia; umbilical hernia; hernioplasty.

Received 11 February 2005; accepted 30 June 2005.

Copyright © 2006 by Multimed Inc.