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Postoperative management and complications after abdominal surgery in children receiving peritoneal dialysis
Yuta Inoki1, Kentaro Nishi1, Kei Osaka1
1Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
Insights
Pediatric patients on peritoneal dialysis (PD) can resume PD within 48 hours after inguinal hernia repair. Resuming PD after laparoscopic surgery with reduced fluid volume may prevent PD fluid leakage.
Area of Science:
- Nephrology
- Pediatric Surgery
- Dialysis
Background:
- Peritoneal dialysis (PD) patients may require abdominal surgery for complications.
- Guidelines for resuming PD and fluid management post-surgery in pediatric patients are lacking.
Purpose of the Study:
- To determine optimal timing and PD fluid prescription for pediatric patients after abdominal surgery.
- To analyze PD-related complications and fluid leakage after small-incision abdominal surgery.
Main Methods:
- Retrospective observational study of pediatric PD patients undergoing small-incision abdominal surgery (May 2006 - Oct 2021).
- Analysis of post-operative complications, PD resumption timing, and PD fluid leakage characteristics.
Main Results:
- 34 patients underwent 45 procedures (hernia repair, catheter repositioning, omentectomy).
- Median PD resumption was 1 day post-op with 25 ml/kg/cycle volume.
- No PD fluid leakage or hernia recurrence after hernia repair; 3/17 patients had leakage after catheter repositioning/omentectomy.
Conclusions:
- PD can be safely resumed within 48 hours after inguinal hernia repair in pediatric patients.
- Resuming PD 3 days post-laparoscopic surgery with half usual dialysate volume may reduce leakage risk.
Background:
Patients on peritoneal dialysis (PD) may develop PD-related complications that necessitate abdominal surgery. However, when to resume PD and how to prescribe PD fluid after surgery in pediatric patients are unknown.
Methods:
Patients on PD who underwent small-incision abdominal surgery between May 2006 and October 2021 were included in this retrospective observational study. The complications after surgery and characteristics of patients with PD fluid leakage were analyzed.
Results:
Thirty-four patients were included. They underwent 45 surgical procedures, including 23 inguinal hernia repairs, 17 PD catheter repositioning or omentectomy, and 5 others. The median time to resume PD was 1.0 (IQR, 1.0-3.0) days, and the median PD exchange volume at the initiation of PD after surgery was 25 (IQR, 20-30) ml/kg/cycle. PD-related peritonitis occurred in two patients after omentectomy and one after inguinal hernia repair. There was no PD fluid leakage or hernia recurrence among the 22 patients who had a hernia repair. Peritoneal leakage occurred in 3 of the 17 patients who had PD catheter repositioning or an omentectomy and was treated conservatively. No patients who resumed PD 3 days after small-incision abdominal surgery with less than half of PD volume had fluid leakage.
Conclusions:
Our findings demonstrated that PD could be resumed within 48 h of inguinal hernia repair with no PD fluid leakage or hernia recurrence in pediatric patients. In addition, resuming PD 3 days after a laparoscopic procedure with less than half of the usual dialysate volume might reduce the risk of PD fluid leakage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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