Simultaneous PD Catheter and Hernia Repair — ESENeph MCQ

Correct answer: E — Simultaneous PD catheter insertion and hernia repair is feasible and is increasingly practised – it reduces the number of surgical procedures, allows earlier PD initiation, and avoids the risk of hernia recurrence from PD pressure before repair

Explanation lettering: D = shown as B · E = shown as C · C = shown as D · B = shown as E

Yes. Simultaneous PD catheter insertion and hernia repair is feasible in an appropriate surgical setting and is an accepted approach for patients preparing for peritoneal dialysis. Symptomatic abdominal wall hernias should be repaired before or at the time of PD access creation because PD increases intra-abdominal pressure, which can enlarge hernias and increase the risk of dialysate leak, incarceration, and recurrence. Combining the procedures reduces the number of anaesthetics/operations, avoids starting PD against an unrepaired defect, and can allow earlier planned PD initiation after postoperative healing or with a low-volume start protocol. Both laparoscopic and open approaches may be used depending on local expertise; laparoscopic catheter insertion can be combined with hernia repair, so options D and E are incorrect.

Reference: UK Kidney Association Clinical Practice Guidelines for Peritoneal Access and Commentary on the 2019 ISPD Update for Creating and Maintaining Optimal Peritoneal Dialysis Access, 2021. https://www.ukkidney.org/sites/renal.org/files/UKKA%20PD%20access%20guidelines%20-%20final%20site%20version.pdf