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Query: UMLS:C0019270 (hernia)
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A simple, non-invasive and well-tolerated technique for routine measurement of intraperitoneal hydrostatic pressure (IPP) in patients treated with peritoneal dialysis (PD) is presented. The height of the dialysis fluid in the PD line was measured, under atmospheric pressure, before drainage and during inspiration (IPPinsp) and expiration (IPPexp), taking the axillary line as the reference point of the resting subject in strict supine position. Normal values were established for a population of 18 patients treated with PD for 19.8 +/- 20.9 months under clinical and biological stable conditions. For an intraperitoneal volume of 2,820 +/- 419 ml, IPPinsp = 14 +/- 2 cmH2O; IPPexp = 12 +/- 2 cmH2O; IPP mean (defined as (IPPinsp+IPPexp)/2) = 13 +/- 2 cmH2O; IPP (defined as IPPinsp - IPPexp) = 2 +/- 2 cmH2O. IPP could not predict mechanical complications (hernia, hemorrhoids, dialysis fluid leakage) but the maximal IPPexp clinically tolerated was 20 cmH2O.
Adv Perit Dial 1992
PMID:Routine measurement of hydrostatic intraperitoneal pressure. 136 62

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.
Adv Perit Dial 1991
PMID:Hernias associated with CAPD in children. 168 Apr 46

Clinical course, complications and outcome were analyzed in 75 patients (14 women, 61 men) who started CAPD at age 55 years or older (55-81). These patients were separated in three groups. Group A patients had high risk for vascular disease (diabetes, hypertension, N = 45), group B patients had a presumed lower risk for vascular disease (primary renal disease, N = 22), and group C patients had miscellaneous conditions (N = 8). Group A was compared to group B. Patient and technique survival was statistically higher for group B than for group A. The rates of peritoneal dialysis related complications (peritonitis, tissue infections, catheter loss, hernias) were comparable between groups A and B. Hernias were seen frequently in all groups and had severe sequellae, including discontinuation of CAPD. Catastrophic vascular events were also seen in all groups, but the frequency of such events, particularly of catastrophic vascular events of the limbs, was statistically higher in group A than in group B. Vascular disease accounted for the majority of deaths in all groups. Four patients died from cardiovascular instability soon after changing from CAPD to hemodialysis. In conclusion, vascular disease is the major factor limiting survival in older CAPD patients. CAPD is superior to hemodialysis for a relatively small fraction of older patients with severe cardiovascular instability.
Adv Perit Dial 1990
PMID:Vascular disease: the critical risk factor for mortality in older patients on CAPD. 198 41

Dialysate leaks, which occurred in 386 CAPD patients over 11 years, were analyzed retrospectively. 18 patients developed 21 early leaks (within 30 days of catheter insertion) and 18 patients developed 28 late leaks (beyond 30 days of catheter insertion). 8 patients had multiple (2-6) leaks. Both early and late leaks, particularly if they were multiple, were associated with conditions that affect adversely tissue healing and tensile strength. Median surgical insertion was apparently associated with a higher incidence of early leaks. Early leaks were manifested externally, usually through the exit site, and did not require imaging. Late leaks were manifested usually by poor dialysate outflow, localized edema and subcutaneous fluid collections. One third of the late leaks required radiological imaging. Hernias caused 42% of the late leaks. Early leaks were managed by temporary discontinuation of CAPD alone (57%) or surgery. Most late leaks (67%) required surgery. Conservative means (change to IPD, observation) were applied for the management of a few late leaks. Both early and late leaks resulted frequently in replacement of peritoneal catheters, but only late leaks resulted in permanent discontinuation of peritoneal dialysis. Paramedian surgical insertion, waiting period of 10-14 days between catheter insertion and initiation of CAPD, and low starting dialysate volumes have resulted in apparent reduction of the incidence of the early, but not of the late leaks. Dialysate leaks have serious consequences on the performance of CAPD. Early leaks differ from late leaks in some clinical manifestations. Preventive measures have decreased the incidence of early, but not of the late leaks.
Adv Perit Dial 1990
PMID:Early and late peritoneal dialysate leaks in patients on CAPD. 198 43

The curled peritoneal dialysis catheter is theoretically less prone to catheter migration and drainage failure. It also allows percutaneous placement, rather than surgical placement exclusively, whenever desired or necessary. Review of 213 curled-catheter placements, 134 (63%) percutaneous and 79 (37%) surgical, over the last 4 years, shows that the probability of continuing catheter function by life-table analysis was 88% at one year, 71% at 2 years, and 61% at three years, with no difference comparing percutaneous to surgical placement. Among the 213 total cases, nearly 50% of all catheters were still functioning at last follow up, and 38 catheters (17.8%) have been lost in total, attributed to infectious complications in 24 cases (tunnel-exit infection alone in 5, peritonitis alone in 11, combined infection in 8), refractory drain failure in 9 cases (early drain failure in 4, late drain failure in 5), recurrent late subcutaneous dialysate leaking in 3 cases, and peri-catheter hernia in 2 cases. Among other complications, the incidence of early drain failure (7.0%), and late drain failure (4.2%), compare favorably to reports describing other devices or other placement methods having comparable size of reported experience. Analyzing our own percutaneous and surgical placements separately, there were no differences in the respective frequencies of early drain failure, late drain failure, late subcutaneous dialysate leaking, outer cuff extrusion, required hernia repair, peritonitis or tunnel-exit infection. Only early external dialysate leaking was more frequent using percutaneous placement methods (21.6% vs. 10.1%; p less than 0.05), although no catheters were lost due to early external leaking.(ABSTRACT TRUNCATED AT 250 WORDS)
Perit Dial Int 1990
PMID:The curled catheter: dependable device for percutaneous peritoneal access. 209 63

To reduce leakage of peritoneal dialysis fluid, insertion of a 2-cuff Tenckhoff catheter (TeC) was performed under local anaesthesia by a lateral approach on 30 occasions in 26 patients. Incision was 3 cm laterally of the linea alba. The inner cuff of the TeC was fixed by a purse-string suture of the peritoneal membrane on the abdominal side of the cuff and another purse-string suture, of the inner fascial blade, around the distal end of the cuff. A third purse-string suture was placed around the TeC at the exit through the outer fascial blade. A subcutaneous tunnel completed the insertion. In all patients, dialysis was started immediately after TeC insertion. The median treatment time was 6.5 months (range 3 days-15 months). No leakage developed in any patient and no hernia was created from this approach. Peritonitis was treated on 8 occasions over a period of 163 months. We conclude that the technique is simple, enables immediate start of dialysis with low risk for leakage.
Perit Dial Int 1990
PMID:Absence of leakage by insertion of peritoneal dialysis catheter through the rectus muscle. 215 Jul 64

Out of a series of 290 surgically inserted continuous ambulatory peritoneal dialysis (CAPD) catheters, 19 patients had 24 abdominal hernias repaired at the same time as CAPD catheter insertion. All catheters were used immediately after our normal postoperative break in protocol. There were no fluid leaks from the hernia repair site but 3 catheters failed due to complications unrelated to the hernia repair. CAPD technique survival was not adversely affected in the hernia repair group.
Perit Dial Int 1989
PMID:Combined abdominal hernia repair and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion. 248 86

We report six patients who presented with genital oedema associated with continuous ambulatory peritoneal dialysis (CAPD) who had no clinically detectable inguinal hernia at the time of initial presentation. In the absence of conventional clinical signs of an inguinal hernia, isotope imaging of the pelviscrotal region after introducing technetium-labelled tin colloid through the dialysis tube has proved to be an accurate guide to localisation of the hernia, has avoided unnecessary bilateral explorations, and has facilitated early repair of the hernia, thus allowing reinstitution of CAPD.
Nephrol Dial Transplant 1987
PMID:A method for demonstrating subclinical inguinal herniae in patients undergoing peritoneal dialysis: the isotope 'peritoneoscrotogram'. 311 68

The study was designed to investigate the incidence of abdominal wall hernias (AWH) and related outcome in all end-stage renal disease (ESRD) patients who started peritoneal dialysis (PD) from January 1989 to December 1993. Between January 1989 and December 1993, a total of 158 ESRD patients (93 male, 65 female) entered our home program and were treated with peritoneal dialysis (PD) over 2789 patient-months. All PD catheters were placed in the lateral by two dedicated surgeons. AWH detected at the time of PD catheter placement was repaired simultaneously. The hernia repair was done using a polypropylene mesh. Inguinal hernias were noted by patients as a mass or discomfort. Umbilical and incisional hernias were observed during clinic visits. Twenty-one (13.3%) abdominal wall hernias were observed in 20 patients (12.7%). Eight (38.1%) inguinal hernias occurred in 8 male patients. Six inguinal hernias were repaired. PD was resumed after a mean of 12 days of hernia repair. Two patients resumed PD in 8 and 14 days without dialysis. One patient transferred to hemodialysis (HD) due to catheter malfunction. No complications occurred related to inguinal hernias. Ten (47.6%) umbilical hernias were observed in 10 patients (7 male, 3 female). The strangulation of umbilical hernias occurred in 2 patients, which required emergency small bowel resection and hernia repair. Both cases were complicated by candida peritonitis and enterobacter peritonitis, requiring PD catheter removal, and patients were then transferred to HD. Three (14.3%) incisional hernias were observed in 3 male patients. Two incisional hernias were repaired. No relation between AWH and PD modalities (CAPD/CCPD/IPD) was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Adv Perit Dial 1994
PMID:Abdominal wall hernias in ESRD patients receiving peritoneal dialysis. 799 71

We reviewed 216 patients on peritoneal dialysis over a 3-year period to assess the effects on patient outcome of short-dwell dialysis (SDD), defined as dwell time below 4 hours with a daily dry (empty peritoneum) interval. Forty-nine patients (23%) required SDD for improved management of ultrafiltration failure (82%), effective blood pressure control (8%), abdominal wall hernia (4%), hydrothorax (4%), and patient convenience (2%). Ultrafiltration failure was recognized as the inability to achieve resolution of clinical overhydration, confirmed by the peritoneal equilibration test (PET), demonstrating high membrane glucose transport (absorption) and observed retention of dialysate volume. Daytime ambulatory peritoneal dialysis (DAPD) was used by 69% of patients and nightly peritoneal dialysis (NPD) with cyclers by 31%. Only one patient (hydrothorax) transferred to hemodialysis. Observations include sustained hydration and blood pressure control in all patients with maintenance of biochemical dialysis adequacy, less reliance on very hypertonic solutions, an increase in dry weight in 25% of patients, decreased use of antihypertensive agents, effective management of hernia and hydrothorax in 3 of 4 patients, and satisfactory patient tolerance of DAPD and NPD regimens, and daily dry intervals. Factors promoting SDD include improved understanding of PET studies, use of disconnect systems, and improvement in cycler design. We anticipate increasing use of SDD as recognition of its usefulness and application techniques expands.
Adv Perit Dial 1993
PMID:Short-dwell peritoneal dialysis: increased use and impact on clinical outcome. 810 61


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