Abdominal hernias in continuous peritoneal dialysis
- Michael Rocco, MD, MS
Michael Rocco, MD, MS
- Professor of Medicine
- Wake Forest University School of Medicine
- John M Burkart, MD
John M Burkart, MD
- Section Editor — Dialysis
- Professor of Medicine/Nephrology
- Wake Forest University Medical Center
Abdominal hernias can be a significant problem in patients treated with continuous peritoneal dialysis (PD) . A discussion of abdominal hernias in patients undergoing peritoneal dialysis will be presented in this topic review.
In the early 1980s, the incidence of abdominal hernia was approximately 10 to 15 percent per year. Historically, the incidence was lower with intermittent than with continuous ambulatory PD, with the former having an annual rate of less than 5 percent .
A subsequent advance, the utilization of a paramedian approach to PD catheter insertion, has significantly reduced the incidence of exit site and incision hernias [3,4]. Hernia rates are currently reported at a rate of 0.04 to 0.08 per patient per year [1,5,6].
RISK FACTORS FOR HERNIA FORMATION
Studies conflict regarding risk factors for hernia formation [4-7]. A large study conducted in the United States of 1864 peritoneal dialysis (PD) patients did not show an association between hernias and patient age, body surface area, PD modality, volume of dialysate, time of largest dwell or type of catheter used. Cystic disease conferred a 2.5-fold increase in risk for anatomic complications; female gender conferred an 80 percent reduction in risk, and Kt/V ≥2.0 conferred a 52 percent reduction in risk (p <0.05) for hernia . From a pathophysiologic standpoint, these risk factors reflect anatomic, hydrostatic, or metabolic factors that can influence hernia formation.
Anatomic sites — The sites of anatomic weakness that predispose to hernia formation include the inguinal canals, umbilicus, linea alba, patent processus vaginalis, exit site, and site of a prior surgical incision. As an example, the testes descend into the scrotum via the processus vaginalis, which should then become obliterated. However, a patent processus vaginalis has been found in 90 percent of infants at birth and, at autopsy, in up to 37 percent of adults without hernias. Leakage of peritoneal fluid into a patent processus vaginalis can result in the formation of an indirect inguinal hernia.
- Yang SF, Liu CJ, Yang WC, et al. The risk factors and the impact of hernia development on technique survival in peritoneal dialysis patients: a population-based cohort study. Perit Dial Int 2015; 35:351.
- Rocco, MV, Stone, WJ. Abdominal hernias in chronic peritoneal dialysis patients: A review. Perit Dial Bull 1985; 5:171.
- Suh H, Wadhwa NK, Cabralda T, et al. Abdominal wall hernias in ESRD patients receiving peritoneal dialysis. Adv Perit Dial 1994; 10:85.
- Spence PA, Mathews RE, Khanna R, Oreopoulos DG. Improved results with a paramedian technique for the insertion of peritoneal dialysis catheters. Surg Gynecol Obstet 1985; 161:585.
- Del Peso G, Bajo MA, Costero O, et al. Risk factors for abdominal wall complications in peritoneal dialysis patients. Perit Dial Int 2003; 23:249.
- Hussain SI, Bernardini J, Piraino B. The risk of hernia with large exchange volumes. Adv Perit Dial 1998; 14:105.
- Van Dijk CM, Ledesma SG, Teitelbaum I. Patient characteristics associated with defects of the peritoneal cavity boundary. Perit Dial Int 2005; 25:367.
- Leblanc M, Ouimet D, Pichette V. Dialysate leaks in peritoneal dialysis. Semin Dial 2001; 14:50.
- Morris-Stiff G, Coles G, Moore R, et al. Abdominal wall hernia in autosomal dominant polycystic kidney disease. Br J Surg 1997; 84:615.
- Dejardin A, Robert A, Goffin E. Intraperitoneal pressure in PD patients: relationship to intraperitoneal volume, body size and PD-related complications. Nephrol Dial Transplant 2007; 22:1437.
- Bargman JM. Complications of peritoneal dialysis related to increased intraabdominal pressure. Kidney Int Suppl 1993; 40:S75.
- Aranda RA, Romão Júnior JE, Kakehashi E, et al. Intraperitoneal pressure and hernias in children on peritoneal dialysis. Pediatr Nephrol 2000; 14:22.
- Bleyer AJ, Casey MJ, Russell GB, et al. Peritoneal dialysate fill-volumes and hernia development in a cohort of peritoneal dialysis patients. Adv Perit Dial 1998; 14:102.
- Twardowski ZJ, Khanna R, Nolph KD, et al. Intraabdominal pressures during natural activities in patients treated with continuous ambulatory peritoneal dialysis. Nephron 1986; 44:129.
- Perl J, Jassal SV, Bargman JM. Persistent peritoneal dialysis catheter exit-site leak in a patient receiving maintenance immunosuppression with sirolimus. Clin Transplant 2008; 22:672.
- García-Ureña MA, Rodríguez CR, Vega Ruiz V, et al. Prevalence and management of hernias in peritoneal dialysis patients. Perit Dial Int 2006; 26:198.
- O'Connor JP, Rigby RJ, Hardie IR, et al. Abdominal hernias complicating continuous ambulatory peritoneal dialysis. Am J Nephrol 1986; 6:271.
- Cherney DZ, Siccion Z, Chu M, Bargman JM. Natural history and outcome of incarcerated abdominal hernias in peritoneal dialysis patients. Adv Perit Dial 2004; 20:86.
- Winchester JF, Kriger FL. Fluid leaks: prevention and treatment. Perit Dial Int 1994; 14 Suppl 3:S43.
- Crabtree JH, Burchette RJ. Effective use of laparoscopy for long-term peritoneal dialysis access. Am J Surg 2009; 198:135.
- Guzmán-Valdivia G, Zaga I. Abdominal wall hernia repair in patients with chronic renal failure and a dialysis catheter. Hernia 2001; 5:9.
- Tast C, Kuhlmann U, Stölzing H, et al. Continuing CAPD after herniotomy. EDTNA ERCA J 2002; 28:173.
- Martínez-Mier G, Garcia-Almazan E, Reyes-Devesa HE, et al. Abdominal wall hernias in end-stage renal disease patients on peritoneal dialysis. Perit Dial Int 2008; 28:391.
- Shah H, Chu M, Bargman JM. Perioperative management of peritoneal dialysis patients undergoing hernia surgery without the use of interim hemodialysis. Perit Dial Int 2006; 26:684.
- Juergensen PH, Rizvi H, Caride VJ, et al. Value of scintigraphy in chronic peritoneal dialysis patients. Kidney Int 1999; 55:1111.
- Cobelo C, Ros S, Trujillo C, Garcia P. An unusual case of vaginal leak in a patient on peritoneal dialysis. Perit Dial Int 2010; 30:665.
- Shavit L, Lifschitz M, Plaksin J, et al. Postcoital peritonitis associated with transvaginal leak of dialysate in a CAPD patient. Perit Dial Int 2006; 26:720.
- Prischl FC, Muhr T, Seiringer EM, et al. Magnetic resonance imaging of the peritoneal cavity among peritoneal dialysis patients, using the dialysate as "contrast medium". J Am Soc Nephrol 2002; 13:197.
- RISK FACTORS FOR HERNIA FORMATION
- Anatomic sites
- Hydrostatic pressure
- Metabolic factors
- CLINICAL MANIFESTATIONS
- DIAGNOSIS OF HERNIAS AND DIALYSATE LEAKS
- Surgical repair of hernias
- Treatment of dialysate leaks with or without hernia
- - Overview
- - Abdominal wall or genital edema
- SUMMARY AND RECOMMENDATIONS