title: Simultaneous abdominal wall defect repair and Tenckhoff catheter placement in candidates for peritoneal dialysis.
abstract: BACKGROUND
  The presence of pre-existing abdominal wall defect (AWD) could represent a potential contraindication for peritoneal dialysis (PD) treatment. We report the results of our 6-year experience involving simultaneous repair of pre-existing AWD and catheter insertion for PD.
  
  
  METHODS
  Patients with estimated glomerular filtration rate (e-GFR) 7-10 ml/min attending a single nephrology clinic between January 2008 and December 2014 were evaluated. Simultaneous AWD repair and catheter placement was performed. For inguinal (IH) or umbilical hernia (UH), a prolene mesh repair technique was adopted. Except for one case of total anaesthesia, the surgical procedure was performed under either spinal or local anaesthesia. Ceftazidime alone or in association with quinolones was administered 1 h before surgery in a single dose. Patients were discharged 2 days after surgery, and returned to the clinic twice during the 1st week for peritoneum washing (first volume of peritoneal dialysis solution: 300 ml). From week 3, volume (2000 ml) and dwells were personalized according to the patient's clinical condition; options were: incremental PD, standard PD, or continuous cycling PD. Surgical follow-up was planned at 1, 6, and 12 months.
  
  
  RESULTS
  Peritoneal catheters were inserted in 170 patients. IH, UH and incisional hernia were found in 18, 2 and 1 patients, respectively. IH was bilateral in 4 patients; concomitant IH and UH occurred in 1 patient. There were no deaths, nor intra-operative complications apart from scrotal haematoma in 1 patient. Over a mean follow-up of 551 days (range 342-1274) no hernia recurrence was registered and the peritoneal catheter continued functioning without problems.
  
  
  CONCLUSIONS
  Simultaneous AWD repair and peritoneal catheter placement seems a reliable and safe surgical procedure that allows patients with AWD to benefit from PD treatment.
authors.affiliation: General Surgical Unit, Department of Public Health, University FEDERICO II Naples, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sodo
authors.affiliation: General Surgical Unit, Department of Public Health, University FEDERICO II Naples, Naples, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Bracale
authors.affiliation: Nephrology, Department of Public Health, University FEDERICO II Naples, Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Argentino
authors.affiliation: General Surgical Unit, Department of Public Health, University FEDERICO II Naples, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Merola
authors.affiliation: Nephrology, Department of Public Health, University FEDERICO II Naples, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Russo
authors.affiliation: Nephrology, Department of Public Health, University FEDERICO II Naples, Naples, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Sannino
authors.affiliation: General Surgical Unit, Department of Public Health, University FEDERICO II Naples, Naples, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Strazzullo
authors.affiliation: Nephrology, Department of Public Health, University FEDERICO II Naples, Naples, Italy. domenicorusso51@hotmail.com.
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D005919:Glomerular Filtration Rate; D006552:Hernia, Inguinal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006554:Hernia, Umbilical / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D000069290:Incisional Hernia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007558:Italy; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D011126:Polypropylenes; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes
keywords: Abdominal wall defect; Inguinal hernia; Peritoneal catheter; Peritoneal dialysis