Inguinal hernias in patients on continuous ambulatory peritoneal dialysis: Report of four surgical cases

Abstract

Inguinal hernia is a relatively common non-infectious complication after starting peritoneal dialysis (PD). Between April 2015 and May 2022, 19 patients were treated with PD. Among them, 3 patients who underwent tension-free repair were analyzed. The patients were all men and their ages at hernia diagnoses were 82, 77, 76, and 76 years, respectively. All patients showed end-stage renal disease due to nephrosclerosis without a history of peritonitis or abdominal surgery. All hernias were diagnosed after the start of continuous ambulatory peritoneal dialysis (CAPD), and automated peritoneal dialysis (APD) was not performed in any cases. The durations from PD to hernia formation were 14, 8, 5, and 1 month, respectively. The hernias were all indirect inguinal hernias, with diagnoses of three cases of L2 and one case of L3 based on the new JHS classification. All cases were repaired by the mesh plug method, and hernia sacs were simply inverted in the abdominal cavity. The periods until the resumption of CAPD after surgery were 12, 5, 3, and 2 days, respectively. Postoperative interim hemodialysis (HD) was performed in 2 cases. All cases returned to CAPD with regular exchange volumes (2.0 L) on the date of resuming CAPD. No recurrence was noted on abdominal examinations for 52, 31, 30, and 23 months, respectively. However, one patient died of sepsis at 52 months after surgery. Mesh plug repair without hernia sac incision is effective for inguinal hernia in patients on CAPD.