Hernia
Significant abdominal wall hernias should be surgically repaired prior to the initiation of peritoneal dialysis. The majority of hernias can be repaired at the time of the catheter implantation. Repair of large or complicated hernias may be staged as a separate procedure in advance of catheter placement or accompanied with an embedded catheter approach when an extended healing period is anticipated to minimize risk of recurrence.
Enlargement of the herniation may occur as a result of increased abdominal wall pressure from intraperitoneal dialysate. Significant hernias left untreated increase the risk of further enlargement, pain, bowel entrapment, and subsequent discontinuation of peritoneal dialysis.1
The most commonly seen hernias are umbilical, inguinal, incisional, and pericatheter. Pericatheter hernias occur more often when the catheter is placed through the midline instead of the paramedian approach through the rectus muscle.