Watchful waiting is an appropriate option for peritoneal dialysis candidates with an asymptomatic ventral hernia.

PURPOSE: Expert consensus recommends that all ventral hernias be repaired prior to, or concomitantly with, peritoneal dialysis (PD) catheter insertion. We examined the clinical outcomes of patients undergoing initial PD catheter insertion, with asymptomatic ventral hernias that were not repaired and rather managed using a watchful waiting approach. METHODS: A single-center, retrospective review of patients undergoing PD catheter insertion from 2005-2019 was performed. Patients who did not undergo repair of a pre-existing ventral hernia at the time of their initial PD catheter insertion were included. The primary endpoint was ventral hernia repair following PD catheter insertion. RESULTS: Forty-one patients were included. Most patients presented with an umbilical hernia (78%). Six patients (15%) underwent ventral hernia repair at a median postoperative interval of 12 months [IQR 8-16], due to abdominal discomfort and hernia enlargement (n = 2) and incarceration (n = 2). Two patients remained asymptomatic, yet underwent ventral hernia repair at the time of renal transplantation. The cumulative incidence of ventral hernia repair within 12 and 24 months of PD catheter insertion was 13% and 21%, respectively. CONCLUSION: Watchful waiting may be an acceptable option for select patients with asymptomatic ventral hernias at the time of initial PD catheter placement. These findings highlight the need to better identify factors associated with asymptomatic ventral hernias that do not warrant concomitant repair to aid surgeons in the decision-making process.

Cephalometric comparison of characteristics in chronically snoring patients with and without sleep apnea syndrome.

OBJECTIVE: The purpose of this investigation is to cephalometrically study 50 snoring patients with and without sleep apnea and to determine whether cephalograms can be used as a diagnostic tool to differentiate persons who are chronic snorers from persons with sleep apnea. STUDY DESIGN: A sample of 30 sleep apnea patients was compared with a sample of 20 chronic snorers without sleep apnea as documented by polysomnography. Forty cephalometric measurements were determined to study various skeletal, soft tissue, and airway abnormalities. RESULTS: This study showed that both groups presented multiple cephalometric abnormalities. Only four measurements differed significantly between the two samples. In the sleep apnea group the maxilla was retropositioned and the hypoid bone displaced inferiorly and distally as compared to nonapneic snorers. CONCLUSIONS: Because of the overall presence of abnormal cephalometric findings in both samples and given similar age and weight ranges, a differential diagnosis between chronic snorers with and without sleep apnea cannot be reliably based on standard cephalometric evaluation alone.

Long-term neurosensory deficits associated with bilateral sagittal split osteotomy versus inverted 'L' osteotomy.

Ten cases of bilateral sagittal split osteotomies and nine cases of intraoral inverted "L" osteotomies were examined for postsurgical neurosensory disturbances. Neurosensory tests included brushstroke direction, temperature, and light touch. All patients completed a short questionnaire that elicited subjective information with respect to neurosensory symptoms and their perception of the surgical results. Analysis of the data obtained from the tests of neurosensory disturbances revealed no significant differences between the two surgical groups. The variance of the scores on each of the neurosensory disturbances measures was significantly greater (p < 0.01) for the BSSO group. Analysis of the data from the questionnaire indicated that BSSO patients were significantly more likely to report postsurgical hypoesthesia of the lip (p < 0.01) and chin (p < 0.001) than the intraoral inverted "L" osteotomies group. None of the intraoral inverted "L" osteotomies group reported a moderate level of hypoesthesia of the lower lip or the chin, 66% reported no lip hypoesthesia, and 89% indicated no hypoesthesia in the chin area. In contrast, 33% of the BSSO group reported moderate hypoesthesia of the lip, and 22% reported moderate hypoesthesia of the chin. All patients in both groups expressed satisfaction with the surgical outcome, and had not changed their opinion on having the surgery. Although the tests of neurosensory disturbances revealed some disparity between the groups, the differences were not statistically significant. However, the subjective impressions of the groups differed regarding postsurgical neurosensory disturbances; the BSSO group related significantly more symptoms.