Abdominal wall hernias in end-stage renal disease patients on peritoneal dialysis.

OBJECTIVE: To describe our experience with hernioplasty in peritoneal dialysis patients and to identify possible risk factors for surgical complications. DESIGN: A 4-year retrospective chart review of data. SETTING: Peritoneal dialysis unit of a university hospital. PATIENTS AND METHODS: 58 hernias in 50 patients were included. Detailed surgical technique and complications were recorded. Possible risk factors included age, gender, weight, height, body mass index, previous surgery, diabetes, time on dialysis, emergency surgery, hospital stay, type of hernia, mesh use, blood hemoglobin, and serum urea, creatinine, and potassium. RESULTS: Complications occurred in 12 hernioplasties (4 wound infections, 2 peritonitis, 4 catheter dysfunction, and 5 re-operations). Recurrence rate was 12% without mesh use and 0% with mesh hernioplasty. Dialysis was re-instituted in 96% of cases within 3 days postoperatively. Identified risk factors for complications were diabetes, low weight, low height, small body mass index, and low serum creatinine. CONCLUSIONS: Mesh hernioplasty in peritoneal dialysis patients is advisable. Postoperative dialysis with low volume is feasible after surgery. Prospective studies will corroborate our risk factors for morbidity.

[Blunt trauma in kidney transplant with preservation of renal function]. / Trauma contuso en un riñón trasplantado con preservación de la función renal.

A 35-year-old male received a living related kidney transplant. At 184 months posttransplantation he suffered a direct right iliac fossa blunt trauma while working on a machine in a steel factory. Graft pain, dysuria and gross hematuria were observed and CT showed a periallograft hematoma. Because of his anemia and graft function deterioration, surgical exploration was warranted. A 500-cc perigraft hematoma was compressing the kidney and ureter, a 5-cm long, 5-mm in depth linear laceration in the lateral aspect of the superior pole of the graft and a 15-mm long, 2-mm in depth linear laceration in the medial aspect of the superior pole were actively bleeding. Major renal arteries and veins were not injured. Both lacerations were closed by suturing the renal parenchyma over gelfoam pledgets with absorbable suture in a buttress fashion. The kidney was salvaged. Serum creatinine was maintained at 1.5 mg/dl during follow-up. A review of the literature showed that few cases of traumatic renal graft rupture with kidney salvage have been reported. Our case is one of them.