Surgical Treatment of Hernias in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

ABSTRACT

PURPOSE: The incidence of hernia is estimated to be 3~5% in the general population. In patients on continuous ambulatory peritoneal dialysis (CAPD), the incidence of hernia is 6~25% and immediate surgical treatment is critical to maintain CAPD. This study was performed to identify clinical characteristics of hernias in CAPD patients and evaluate the surgical results. METHODS: We retrospectively analyzed 13 prospectively registered patients (malefemale=121) on CAPD treated with hernia between March 1998 and June 2008 at the Seoul National University Hospital by one surgeon. Perioperatively, patients underwent intermittent hemodialysis via internal jugular catheter indwelled just before the operation. Peritoneal dialysis was resumed between 2 weeks and 2 months after operation. RESULTS: Mean age was 46.6 years (range 19~71 years). Fifteen hernias developed in 13 patients, of which, 10 (67%) were inguinal and 5 (33%), umbilical. Mean duration from CAPD start to onset of hernia was 31.4 months (range 0~129 months). All inguinal hernia patients received standard McVay operation, 3 patients with umbilical hernia were repaired with primary herniorrhaphy and 1 patient with large fascial defect needed mesh implant. During mean follow-up periods of 31 months, recurrence was detected in 1 patient in umbilical hernia group. The only complication related to operation was wound hematoma in one patient. Two patients were converted to hemodialysis after operation because of low compliance to peritoneal dialysis in one patient and suspected catheter-related infection in the other. CONCLUSION: Our results indicate that hernia repair can be safely performed with acceptable outcomes in patients on CAPD.