Abstract
PurposeOccult inguinal hernias (IH) predispose peritoneal dialysis (PD) patients to the symptomatic IH formation after starting PD, which may cause complications. We conducted a retrospective study to assess the benefit/risk profile of routine laparoscopic examination for occult IH (RLEOH) with a synchronous repair in patients receiving PD catheter placement.Methods432 patients were enrolled in this study. Patients with an internal hernia sac at all sizes were deemed to have occult IH. We retrospectively reviewed data including demographic characteristics and operative details. We also measured incidence rates of symptomatic IH, metachronous IH repair, and catheter survival over a follow-up period after starting PD.ResultsThese patients were classified into the RLEOH group (n = 365) and the non-RLEOH group (n = 67). The RLEOH group was subdivided into occult IH with a synchronous repair (n = 17; the subgroup A), no occult IH (n = 339; the subgroup B), and occult IH without a synchronous repair (n = 9; the subgroup C). The incidence rates of symptomatic IH developed after staring PD in subgroups A, B, and C were 0, 5.6, and 22.2%, respectively, whereas that in the non-RLEOH group was 13.4%. The RLEOH group had a reduced hazard ratio for metachronous IH repair compared with the non-RLEOH group (HR = 0.426; 95% CI 0.195–0.930, p = 0.032). None of our patients suffered from herniorrhaphy-related complications.ConclusionRLEOH with a synchronous repair during PD catheter insertion confers clinical benefits in reducing the risk of developing IH after starting PD and the need for a metachronous repair. This is a safe and reasonable approach.
Highlights
Continuous ambulatory peritoneal dialysis (PD) has been increasingly used for renal replacement therapy in end-stage renal disease because it has several advantages over hemodialysis such as ease of use and relatively low cost [1,2,3]
Our results clearly show that patients who received routine laparoscopic examination for occult IH (RLEOH) had a reduced risk of metachronous inguinal hernia repair compared to those in the non-RLEOH group
This benefit is mainly due to the fact that a majority (65.4%) of the patients in the RLEOH group who had occult inguinal hernia received a synchronous hernia repair. None of these patients developed symptomatic inguinal hernias during the follow-up period after starting PD, reducing the need for a metachronous surgery. This favorable outcome is in contrast to the finding that more than one-fifth of the patients (22.2%) who had confirmed occult inguinal hernia without a synchronous repair eventually developed symptomatic inguinal hernias after starting PD
Summary
Continuous ambulatory peritoneal dialysis (PD) has been increasingly used for renal replacement therapy in end-stage renal disease because it has several advantages over hemodialysis such as ease of use and relatively low cost [1,2,3]. It is manually performed with injection of the dialysate into the peritoneal cavity via a trans-abdominal catheter 3–4 times every day at home [2, 3]. It has been suggested that this technique allows the identification of occult inguinal hernias during PD catheter insertion [5, 10]. No comparative study has been conducted to provide evidence of clinical benefits supporting this recommendation
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