title: Prevalence and management of hernias in peritoneal dialysis patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  122 patients who started CAPD from 1994 to 2000; 26 hernias were diagnosed in 21 (17.2%) patients.
  
  
  METHODS
  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 pre-existing hernias. Under local anesthesia, most patients were operated on with surgical techniques of tension-free hernioplasty using a polypropylene mesh. Only mild post-operative 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.
authors.affiliation: Department of Surgery, Puerta del Mar University Hospital, Spain. mgarciau@meditex.es
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: García-Ureña
authors.forename: César Remón
authors.initials: CR
authors.lastname: Rodríguez
authors.forename: Vicente
authors.initials: V
authors.lastname: Vega Ruiz
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Carnero Hernández
authors.forename: Evaristo
authors.initials: E
authors.lastname: Fernández-Ruiz
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Vazquez Gallego
authors.forename: Miguel
authors.initials: M
authors.lastname: Velasco García
mesh_terms: D000368:Aged; D005260:Female; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies