Continuous Ambulatory Peritoneal Dialysis After Intra-Abdominally Placed Synthetic Mesh for Ventral Hernia Repair

Abstract

We present a unique experience with a patient who had undergone continuous ambulatory peritoneal dialysis (CAPD) after laparoscopic repair of ventral incisional hernia (LRVIH) with an expanded polytetrafluoroethylene (e-PTFE) mesh (DualMesh(®); WL Gore) and who later suffered from multiple episodes of CAPD-related peritonitis without any signs of mesh infection. A 48-year-old man with an open abdominal aortic reconstruction in 1994 for occlusive arterial disease presented with an incisional ventral hernia. He underwent LRVIH using an e-PTFE mesh of 30×20 cm. Postoperatively, he developed renal failure. For various reasons, the only therapeutic option was CAPD. A CAPD-catheter was implanted via laparoscopy, taking care not to compromise the mesh that was completely covered with neoperitoneum. After 3 months of uneventful CAPD, he developed a bacterial peritonitis. Antibiotic treatment failed and the CAPD-catheter was removed. The mesh was left in place and the patient recovered. Later on another CAPD-catheter was implanted via laparoscopy and used for 10 months. Again he developed peritonitis from which he recovered after catheter removal. Mesh was left in place and remained uninfected, probably protected from intra-abdominal bacteria by the neoperitoneum. The risk of secondary infection of an intra-abdominal mesh seems to diminish largely after neoperitonealization of the mesh. CAPD seems possible in a patient with an intra-abdominal mesh when it is covered with neoperitoneum.