Prevalence and management of hernias in peritoneal dialysis patients.
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.
García-Ureña
Miguel Angel
MA
Department of Surgery, Puerta del Mar University Hospital, Spain. mgarciau@meditex.es
Rodríguez
César Remón
CR
Vega Ruiz
Vicente
V
Carnero Hernández
Francisco Javier
FJ
Fernández-Ruiz
Evaristo
E
Vazquez Gallego
Jose Manuel
JM
Velasco García
Miguel
M
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