Title : Choice of anterior abdominal wall plasty in CKD patients with inguinal hernias
Abstract:
Introduction: Surgical methods of hernia repair are similar in HD and non-dialysis patients. Although anterior abdominal wall hernia is a contraindication to PD, it is common in CKD patients receiving PD.
Materials: In our center, we divided CKD patients receiving PD and diagnosed with inguinal hernia into 3 groups according to the surgical technique used. Patients of all three groups were operated with eTER, TARR and Lichtenstein technique, respectively, and matched for age, gender, CKD severity, comorbidities, and hernia size.
Results: In Group 1, PD was resumed 2 days after surgery and was well tolerated. Patients in Group 2 and 3 received PD on postoperative days 5-7 at the earliest. The reason for temporary refusal of PD was post-TARR peritoneal healing time in Group 2 and PD-associated pain syndrome in the surgical area in Group 3. During that period, patients in both groups had to be preventively transferred to temporary HD, which required an additional hospital stay or transfer to a nephrology department for the placement of tunneled central venous catheter (TCVC) to initiate HD.
Conclusions: Endoscopic extraperitoneal hernia repair (eTER) in CKD patients receiving PD with a diagnosed anterior abdominal wall hernia has all the advantages of minimally invasive surgery over conventional surgery, in addition to avoiding HD. With eTER, there is a significantly reduced risk of infectious and thromboembolic complications associated with TCVC placement and hemodialysis. Patients need less medications, have a shorter hospital stay and rehabilitation period. Therefore, eTER could be recommended as a treatment of choice for anterior abdominal wall hernia repair in CKD patients receiving PD.
Key words: peritoneal dialysis, Endoscopic extraperitoneal hernia repair (eTER), inguinal hernia.
