Abdominal Hernias With Peritoneal Dialysis

Complications related to peritoneal dialysis (PD) can be categorized as infectious or noninfectious. Noninfectious complications, including abdominal hernias, catheter malfunction, and exit site leaks, occur in continuous ambulatory PD (CAPD), continuous cycling PD/automated PD (CCPD/APD), and intermittent PD (IPD). More serious complications, such as catheter erosion into the bowel, bladder, or vagina, are rare and related to the presence of a catheter irrespective of the form of PD used.

Abdominal hernias are the most common of the anatomic complications of PD and contribute significantly to morbidity, increased medical costs, and withdrawal from PD.

Incidence and Prevalence

The prevalence of PD-related hernias ranges from 7% to 25% based on a number of completed studies. However, the incidence of hernias has dropped from 0.21 hernias per PD-year at risk since the early 1980s to about 0.06 hernias per PD-year at risk in late 1990s. This finding may be attributable to the discontinuation of midline catheter insertions and resorbable suture material. Emerging evidence demonstrates a further decline in the incidence of hernias, with 0.04 hernias per PD-year at risk being reported in 2014.

Types of Abdominal Wall Hernias

Several locations of hernia formation have been described in patients undergoing PD, including inguinal, catheter exit site, umbilical, incisional, ventral, epigastric, pelvic, femoral, and obturator. Although the prevalence rates vary in the literature, the most commonly occurring hernias are inguinal hernias. They account for 75% of abdominal wall hernias. Indirect inguinal hernia was more frequent in PD patients than in hemodialysis (HD) patients due to the internal ring expansion via an increase of intra-abdominal pressure from peritoneal dialysate.

Hernial sacs may contain subcutaneous fat, bowel, or peritoneal fluid (or a combination). Unusual hernias such as spigelian, Ritchers, foramen of Morgagni or diaphragmatic, rectocele, cystocele, and uterine prolapse have also been reported in the PD population.

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