J. D. Thomas1, A. Fafaj1, S. J. Zolin1, R. Naples1, C. M. Horne1, D. M. Krpata1, A. S. Prabhu1, C. C. Petro1, M. J. Rosen1, S. Rosenblatt1 1Cleveland Clinic,Cleveland, OH, USA
Introduction: In patients undergoing continuous ambulatory peritoneal dialysis (CAPD) catheter placement, the presence of a pre-existing hernia is thought to be associated with postoperative complications such as dialysate leak, edema, pain, and incarceration. Current guidelines recommend that ventral hernias be repaired prior to, or during, CAPD catheter insertion. However, the data surrounding this recommendation is limited. This study examines the outcomes of patients undergoing initial CAPD catheter insertion who had asymptomatic ventral hernias that were not concomitantly repaired. We hypothesized that a majority of the patients would not require subsequent ventral hernia repair (VHR).
Methods: A single-center, retrospective review of all patients undergoing CAPD catheter insertion between 2005 and 2019, via laparoscopic rectus sheath tunneling technique, was performed. Patients with a pre-existing ventral hernia that was not concomitantly repaired at the time of their initial CAPD catheter insertion were included. Ventral hernias were diagnosed during preoperative physical exam or via diagnostic laparoscopy; the ventral wall defect size was not routinely measured. Patients undergoing CAPD catheter replacement, revision, or removal were excluded. The primary endpoint was subsequent VHR following CAPD catheter insertion. The cumulative incidence of subsequent VHR over time was estimated using the Kaplan-Meier method. Indication for VHR was also examined.
Results: Of 705 patients who underwent CAPD catheter placement, 44 had an asymptomatic ventral hernia that was not concurrently repaired. The majority of these patients were male (72.7%) with a median age of 62 years (IQR 49-70) and median BMI of 29.1 (IQR 24.5-34.8). Most patients presented with an umbilical hernia (n=32; 72.7%). Six patients (13.6%) ultimately underwent VHR at a median follow-up time of 16 months (IQR 8-25), primarily due to patient-reported increase in size and abdominal discomfort (n=3; 50%). Hernia incarceration led to VHR in one case. Two patients remained asymptomatic, yet underwent VHR at the time of renal transplantation. The cumulative incidence of VHR within 12 and 24 months of initial CAPD catheter insertion was 9.4% and 17.2%, respectively (Figure 1).
Conclusion: Despite current guidelines, most patients in this series undergoing initial CAPD catheter placement without concomitant VHR did not require repair of a symptomatic ventral hernia at relatively long-term follow-up.
