Herniae

Abdominal herniae can be a significant concern in continuous peritoneal dialysis patients(1–3). Hernia rates among patients undergoing PD are currently reported at a rate of 0.04 to 0.08 per patient per year. The mean time for development is one year with an annual increased risk of 20% for each year on PD. In recent years, the paramedian approach to catheter placement has reduced the incidence of exit site and incisional herniae.

Risk Factors

  • Older patients
  • Time on PD
  • Previous hernia repair
  • Previous laparotomies
  • Polycystic kidneys
  • Intra-abdominal masses
  • Collagen diseases
  • Obesity
  • Small body size
  • Malnutrition

Diagnosis

The clinical manifestations are painless swelling at the site of herniation.  The presence of tenderness, Gram negative peritonitis, bowel obstruction or perforation suggests incarceration and/or bowel strangulation.

Prevention and Treatment

To reduce the risk of herniae, it is best to avoid catheter placement over the linea alba and instead use a para median approach with insertion through the rectus muscle.  Infusion of high volumes of dialysate should be delayed until the catheter has completely healed.  If PD start is mandatory, the use of reduced volumes in the supine position are recommended.

Large ventral herniae offer little risk of bowel incarceration but are prone to enlarge.  Small herniae offer higher risk of bowel strangulation and should be promptly repaired.  Traditional surgical techniques are used to repair the hernia, including reinforcement of the abdominal wall with polypropylene mesh whenever necessary.

References:

  1. Bargman JM. Noninfectious Complications of Peritoneal Dialysis. In: Khanna R, Krediet RT, eds. Nolph and Gokal’s Textbook of Peritoneal Dialysis. Third. New York: Springer; 2009:571-609.
  2. McCormick BB, Bargman JM. Noninfectious complications of peritoneal dialysis: implications for patient and technique survival. J Am Soc Nephrol. 2007;18(12):3023-3025. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18003770.
  3. Rocco M, Burkart JM. Abdominal hernias in continuous peritoneal dialysis. UpToDate. 2016. Available from: https://www.uptodate.com/contents/abdominal-hernias-in-continuous-perito…?

The information and reference materials contained in this document are intended solely for the general education of the reader. It is intended to provide pertinent data to assist you in forming your own conclusions and making decisions. This document should not be considered an endorsement of the information provided nor is it intended for treatment purposes and is not a substitute for professional evaluation and diagnosis. Additionally, this information is not intended to advocate any indication, dosage or other claim that is not covered, if applicable, in the FDA-approved label.

P/N 102502-01 Rev A 06/2016