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PRINCIPLES OF ABDOMINAL SURGERY IN PATIENTS ON INTERMITTENT PERITONEAL DIALYSIS

From the Departments of Surgery and Medicine (Division of Nephrology), University of Toronto and St. Joseph's Health Centre, Toronto, Ontario, Canada. Supported by the St. Joseph's Health Centre and Nelson Art hur Hyland Foundations.

Abdominal operations were required in 21 patients on intermittent peritoneal dialysis (IPD) -13 elective, eight emergency. There was one death in the elective group (inguinal herniorrhaphy) and four deaths in the emergency group (three spontaneous colonic perforations and one strangulated ventral hernia). Wound complications occurred in seven patients. Wounds require secure, watertight closure to prevent dialysis leak. In elective abdominal surgery, IPD should be carried out shortly before operation to delay dialysis for a few days after operation and also to decrease platelet dysfunction. Hernias should be repaired electively. Constipation should be avoided. Preoperative transfusion for anemia is generally unnecessary. Drains should be avoided or removed before resumption of IPD. Postoperative IPD should be done with one-liter exchanges. In certain instances, transfer to hemodialysis is indicated.

Copyright © 1983 by Multimed Inc.