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PD Hernia Repair Perioperative Management — ESENeph MCQ

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ModeratePeritoneal DialysisPD Hernia Repair Perioperative ManagementESENeph

A 60-year-old woman on PD develops symptomatic inguinal hernia. She needs surgical repair. What PD management is needed perioperatively?

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Correct answer: A — Temporarily switch to low-volume supine exchanges or temporary HD perioperatively; after repair, gradually resume PD with reduced volumes (starting at 1L exchanges) before returning to full prescription over 2-4 weeks

Hernia repair in PD patients requires perioperative PD prescription modification to avoid increased intra-abdominal pressure on the surgical repair site. Options include: (1) temporary HD for 1-2 weeks post-operatively; (2) low-volume supine APD exchanges (500-1000 mL) starting 24-48 hours post-operatively; (3) gradual return to full volume (increase by 500 mL every few days) over 2-4 weeks. Laparoscopic repair may allow earlier return to PD than open repair. Mesh repair is preferred for lower recurrence rates. Prophylactic hernia repair at catheter insertion can be considered in high-risk patients.

Reference: ISPD 2017 – PD Complications; UKKA 2017 – PD