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Hernias associated with CAPD in children
A E Khoury1, J Charendoff, J W Balfe
1Division of Urology & Nephrology, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Pediatric patients on peritoneal dialysis (PD) have a high incidence of hernias, particularly inguinal hernias in males under 2. Prompt surgical repair with Cooper ligament reinforcement and bilateral repair in young males is recommended.
Area of Science:
- Pediatric Surgery
- Nephrology
- Gastroenterology
Background:
- Peritoneal dialysis (PD) is a treatment for kidney failure.
- Hernias are a known complication in patients undergoing PD.
- The incidence and optimal management of hernias in pediatric PD patients require further investigation.
Purpose of the Study:
- To determine the incidence of hernias in pediatric patients on PD.
- To identify risk factors for hernia development and recurrence.
- To recommend optimal surgical management strategies for hernias in this population.
Main Methods:
- Retrospective review of 79 pediatric patients on PD.
- Analysis of hernia occurrence, type, and patient demographics.
- Evaluation of surgical repair techniques and recurrence rates.
Main Results:
- Twenty-eight hernias occurred in 18 of 79 pediatric PD patients.
- Inguinal hernias were most common, particularly in males under 2 years old.
- High recurrence rates were observed with simple hernia sac ligation.
Conclusions:
- Pediatric PD candidates require thorough hernia screening.
- Prompt, elective inpatient hernia repair is crucial.
- Surgical correction should include Cooper ligament repair; bilateral repair is advised for males under 2, even with unilateral presentation.
Abstract:
Twenty-eight hernias occurred in eighteen of seventy-nine pediatric patients on peritoneal dialysis (PD). There was 18 inguinal hernias (6 bilateral) in 12 patients (11 boys and 1 girl) the average age of the male patients with inguinal hernias was 5.2 years vs 9.3 years for the remaining 32 males. Four of the 11 patients were under 2 years old, where as only 3 of the remaining 32 patients were less than 2 (p less than 0.05), and 3 of the 6 patients with bilateral hernias were under 2. A high incidence of recurrent hernias was noted when only high ligation of the hernia sac was performed. We conclude that all candidates for PD should be carefully evaluated for the presence of occult hernias, hernias should be repaired promptly and electively on an inpatient basis, surgical correction of hernias should include a formal Cooper ligament repair and males under 2 should have bilateral repairs done even if they present with a single hernia.