Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension-free mesh repair feasible?
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RESEARCH ARTICLE
Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: is tension‑free mesh repair feasible? Qiyu Chi, Zheng Shi, Zhibo Zhang, Chunzhong Lin, Guozhong Liu and Shangeng Weng*
Abstract Background: Continuous ambulatory peritoneal dialysis (CAPD), which often causes a common complication such as abdominal wall hernia, is a prevalent alternative therapy for end-stage renal failure patients. However, relevant studies are somewhat rare, and the peritoneal dialysis (PD) protocol during the perioperative period is still controversial. The aim of this study was to evaluate the effectiveness and perioperative management of tension-free mesh repair for inguinal hernias in CAPD patients. Methods: Between January 2013 and December 2019, 18 CAPD patients with 20 inguinal hernias who underwent tension-free mesh repair were retrospectively analyzed. Data on demographics, perioperative features, the perioperative dialysis protocol and surgical complications were collected and assessed. Results: All hernias were diagnosed after the start of CAPD, and the median duration from PD onset to hernia formation was 16 months (2–61 months). All patients underwent successful tension-free mesh repair, including 17 Lichtenstein and 3 anterior Kugel procedures. The median operation time was 62.5 min, and the median postoperative hospital stay was 3 days. Fifteen patients received low-exchange volumes and high-frequency exchanges from 1 to 3 days after surgery for 2 weeks with gradual resumption of the original CAPD regimen within 4 weeks. Complications included seroma (n = 2) and hematoma (n = 1). No wound or mesh infection or recurrence occurred during the follow-up period. Conclusions: Tension-free mesh repair is safe and feasible for inguinal hernias in CAPD patients, The Lichtenstein mesh repair should be the first choice, and anterior Kugel repair may be considered an effective procedure. Bridging hemodialysis seems unnecessary except for emergency surgery. Keywords: Inguinal hernia, Tension-free, Mesh repair, Peritoneal dialysis Background Continuous ambulatory peritoneal dialysis (CAPD) is a prevalent and acceptable alternative therapy for patients with end-stage renal failure (ESRL) and has many economic benefits, is convenient, avoids the pain *Correspondence: [email protected] Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Fujian Medical University, and Fujian Provincial Institute of Abdominal Surgery, No.20 Chazhong Road, Fuzhou 350005, Fujian, China
of establishing the vascular access needed for hemodialysis (HD) and provides a survival advantage while retaining residual renal function (RRF) [1–3]. Abdominal wall hernia is an unavoidable noninfectious complication in CAPD patients that is considered to be caused by the sustained increase in intra-abdominal pressure caused by injecting a large amount of dialysate during CAPD and by deterioration of abdominal wall tissue at this stage [4, 5]. The main types of hernias in CAPD patients include ingui
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