Abdominal wall hernias as a complication of peritoneal dialysis

Home peritoneal dialysis has recently become an important addition to the therapy of chronic renal failure. Abdominal wall hernias have become more apparent as complications of this mode of dialysis, with isolated instances of incarcerations and one fatality. Results of our review of 276 patients receiving peritoneal dialysis revealed seven with hernias, an incidence of 2.5 per cent. Six patients with hernias were receiving c.a.p.d.; one patient was receiving c.c.p.d., and none was receiving i.p.d., for incidences of 17, 5 and zero per cent, respectively. All hernias found at presentation occurred within two to 20 months after peritoneal catheter placement. Most were ventral or umbilical, and all were repaired electively without serious complications. All patients with hernias had associated problems with leaks, peritonitis or predialysis hernias. In two of four patients with predialysis hernias, herniorrhaphy without catheter removal resulted in two recurrences. Abdominal wall hernias are a more frequent complication of c.a.p.d. and c.c.p.d., modalities which require large volumes of peritoneal dialysate during ambulatory hours. Review of the literature reveals that wound tensile strength and healing are decreased in those patients having renal disease with uremia, anemia and malnutrition. However, these factors do not increase the over-all incidence of hernias. Patients should be screened for hernias, and hernias should be repaired prior to catheter placement. Hernias presenting during dialysis are best treated by herniorrhaphy and hemodialysis postoperatively or low volume peritoneal dialysis to optimize the metabolic state.