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Iorga C, Iorga CR, Andreiana I, Stancu SH, Bengulescu I, Strambu V. Management and Outcomes for Peritoneal Dialysis Patients Diagnosed with Abdominal Hernias. Life (Basel) 2024; 14:1003. [PMID: 39202745 PMCID: PMC11355677 DOI: 10.3390/life14081003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND/OBJECTIVES The success of peritoneal dialysis is highly dependent on the integrity of the abdominal wall. Therefore, routine examination and treatment of abdominal hernias can prevent peritoneal dialysis (PD) failure, discontinuation, and conversion to hemodialysis. In this present study, we present our examination protocol for patients proposed for PD and our attitude in treating parietal defects in patients on peritoneal dialysis. OBJECTIVES highlight whether PD is a risk factor for the occurrence of ventral hernias, the relationship between associated pathologies and the occurrence of hernias and the need for an HD switch in the postoperative period. METHODS Between January 2016 and December 2022, a group of 133 patients proposed for insertion of a PD catheter were evaluated according to the protocol established by our hospital. Routine examination for the diagnosis of abdominal hernias and repair before starting the DP is part of the procedure. We included patients with a 3 year minimum follow-up after insertion and evaluated the incidence of parietal defects that appeared during PD treatment. RESULTS Nine patients were diagnosed and operated on for abdominal hernia before starting peritoneal dialysis and none of them had a recurrence of hernia during PD. Twelve patients were diagnosed with abdominal hernias during dialysis treatment (9% incidence) and the median length of time at which parietal defects occur during PD is 12.5 months [range 2-48]. Median BMI is 27.12 [range 22.3-31.24], with a female-male ratio of 2:1 Five patients were transferred to HD, three permanently and two patients temporarily. No patient abandoned PD treatment due to the presence of an abdominal parietal defect. CONCLUSIONS Diagnosis of ventral hernias prior to the time of catheterization for PD leads to a decrease in the incidence of parietal defects during PD and is mandatory in patients who are candidates for PD. Open alloplastic surgical procedures are safe procedures with a low recurrence rate in PD patients. The postoperative continuation of PD is feasible but the decision is to be made by the multidisciplinary team and individualized for each patient.
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Affiliation(s)
- Cristian Iorga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (S.H.S.); (I.B.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Cristina Raluca Iorga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (S.H.S.); (I.B.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Iuliana Andreiana
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (S.H.S.); (I.B.); (V.S.)
- Nephrology Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Simona Hildegard Stancu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (S.H.S.); (I.B.); (V.S.)
- Nephrology Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Iustinian Bengulescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (S.H.S.); (I.B.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
| | - Victor Strambu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.I.); (S.H.S.); (I.B.); (V.S.)
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
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Hao L, Hong X, Sha H, Zhao Y. Treatment of recurrent hernia in peritoneal dialysis patients. J Surg Case Rep 2023; 2023:rjad592. [PMID: 37901609 PMCID: PMC10607540 DOI: 10.1093/jscr/rjad592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/08/2023] [Indexed: 10/31/2023] Open
Abstract
Peritoneal dialysis (PD) is the most commonly used treatment for patients with end-stage renal disease and has the advantages of simple operation and low treatment costs. However, long-term PD may lead to inguinal hernia formation, which needs to be repaired as early as possible. There are many studies on this kind of hernia, but there are few reports about how to treat recurrent hernia in PD patients. Therefore, we present a case of a female PD patient who suffered from a recurrent femoral hernia after primary hernioplasty. We successfully proceeded with treatment by laparoscopic transabdominal preperitoneal hernia repair. The patient was scheduled to receive temporary haemodialysis until the normal PD dose was restored. After 36 months of follow-up, we found that there was no recurrence of hernia, and the function of the PD catheter was normal.
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Affiliation(s)
- Long Hao
- Department of General Surgery, Ningbo Yinzhou No.2 Hospital, Ningbo 315000, China
| | - Xiaoming Hong
- Department of General Surgery, Ningbo Yinzhou No.2 Hospital, Ningbo 315000, China
| | - Hongcun Sha
- Department of General Surgery, Ningbo Yinzhou No.2 Hospital, Ningbo 315000, China
| | - Yu Zhao
- Department of Nephrology, Ningbo Yinzhou No.2 Hospital, Ningbo 315000, China
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Chiu PH, Liu JM, Hsieh ML, Kao WT, Yu KJ, Pang ST, Lin PH. The risk factors of the occurrence of inguinal hernia in ESRD patients receiving dialysis treatment: An observational study using national health insurance research database. Medicine (Baltimore) 2022; 101:e31794. [PMID: 36626542 PMCID: PMC9750606 DOI: 10.1097/md.0000000000031794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
With the quickly growing population of patients receiving dialysis treatment in Taiwan in recent years, concerns about whether more incidence of inguinal hernia exists in dialysis patients are increasing. In Taiwan, peritoneal dialysis (PD) and hemodialysis (HD) are the 2 most common dialysis types. Therefore, the relationship between dialysis type and inguinal hernia occurrence needs to be evaluated and compared. Our retrospective cohort study included a study population total of 3891 patients diagnosed with end stage renal disease (ESRD) under the HD or PD procedure from 2001 to 2009 from the Longitudinal Health Insurance Database. Also, International Statistical Classification of Diseases and Related Health Problems 9th Revision codes were used to identify ESRD and hernia occurrence. Cox proportional-hazards regression model was applied to measure the risk factors to the hernia occurrence. During the follow-up periods of 3 years, the number of hernia occurrences was 44 (1.13%), 1 (0.03%), and 8 (0.21%) with inguinal, femoral, and ventral hernias, respectively. Only the dialysis type revealed significantly increased hernia risk because PD would increase hernia risk 7 times (adjusted hazard ratio [aHR] = 6.98, 95% CI = 3.59-13.25) than HD. If the patients received PD and shifted to HD later, the risk of hernia was 5 times (aHR = 4.98, 95% CI = 2.29-10.85) than patients with HD. Patients with ESRD receiving PD or PD-HD shift were risk factors of inguinal hernia occurrence. The results may help clinicians increase the alert of possible risk factors and complications at the beginning of dialysis treatment in patients with ESRD.
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Affiliation(s)
- Pin-Han Chiu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jui-Ming Liu
- Department of Urology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wei-Tang Kao
- Research Center of Urology and Kidney, Taipei Medical University (TMU-RCUK), Taipei, Taiwan
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Po-Hung Lin Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (e-mail: )
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Duquennoy S, Leduc V, Podevin E. Imaging and leaks in peritoneal dialysis. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i2.61763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysate leaks are non-rare mechanical but dreaded complications in peritoneal dialysis (PD). They usually occur at the beginning of PD, with various clinical events depending on their location. Use of imaging tests such as computed tomography (CT) peritoneography, or magnetic resonance imaging (MRI) peritoneography, or scintigraphic peritoneography, can confirm the diagnosis and guide surgical intervention if needed. These simple, non-invasive, and accessible tests can be done in collaboration between the radiological et peritoneal teams. Depending on the leakage site, PD can be pursued with small volumes with a cycler. In other cases, it must be interrupted and the patient transferred to hemodialysis, in order to permit the peritoneal cavity to regain its integrity by cicatrization or with surgical intervention. Imaging can help to make sure peritoneal cavity has regained its integrity after this period of transition. Early leaks can be avoided by delaying PD start with by 14 days. Intraperitoneal pressure does not seem to contribute significantly. Prevention of PD leaks essentially depends on individual risk factors such as obesity or anterior abdominal surgeries. This article reviews the characteristics of dialysate leaks in PD and the imagery tests to limit transfer to hemodialysis.
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Bauer K, Heinzelmann F, Vogel R, Büchler P, Mück B. Robotically assisted enhanced-view totally extraperitoneal repair (eTEP) of a recurrent umbilical hernia in a patient with peritoneal dialysis. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2021; 10:Doc08. [PMID: 34194919 PMCID: PMC8204666 DOI: 10.3205/iprs000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Abdominal wall hernias are frequent in patients with peritoneal dialysis. Guidelines recommend an open hernia repair with extraperitoneal mesh placement to avoid access to the abdominal cavity. Method: We performed a lateral docking robotically assisted enhanced-view totally extraperitoneal repair (eTEP) of a recurrent umbilical hernia with diastasis recti in a patient with peritoneal dialysis due to polycystic kidney disease. After suturing of the midline a 20 x 28 cm mesh was placed in the retrorectus space, covering the whole area of preparation while also overlapping all trocar sites. A drainage was left in the retrorectus space until the first session of PD did not sample any form of leakage. Result: Robotically assisted totally extraperitoneal hernia repair was feasible. The patient was able to continue peritoneal dialysis without intermittent hemodialysis. There was no leakage of the dialysate to the retrorectus space. Postoperative recovery was uneventful. 6 months after surgery the patient was free from pain and showed no signs of recurrence. Conclusion: Robotically assisted totally extraperitoneal hernia repair in patients with umbilical hernia and peritoneal dialysis could be a promising surgical technique to combine the advantages of minimally-invasive surgery with totally extraperitoneal mesh placement without access to the abdominal cavity.
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Affiliation(s)
- Katrin Bauer
- Abteilung für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Kempten, Germany
| | - Frank Heinzelmann
- Abteilung für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Kempten, Germany
| | - Robert Vogel
- Abteilung für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Kempten, Germany
| | - Peter Büchler
- Abteilung für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Kempten, Germany
| | - Björn Mück
- Abteilung für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Kempten, Germany
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