Incisional hernia after corrective surgical omentectomy for PD catheter dysfunction

초록

Surgical omentectomy is occasionally performed when non-invasive or peritoneoscopic correction methods fail to relive peritoneal dialysis (PD) catheter dysfunction. We reviewed the incidence and outcomes of incisional hernia followed corrective surgical omentectomy for catheter dysfunction after implantation in 144 patients at our institute, where PD catheter was implanted blindly using trocar. Surgical omentectomy was performed in 11 (7.6%) patients with paramedian incision and interrupted/continuous layered suture using Vicryl. CAPD initiated in bed resting state with reduced volumes, 500mL per 6 hour for 4 days and 1000mL per 6 hour for 3 days. Incisional hernia developed in 4 out of 11 patients (36.4%) at 5, 6, 8 and 11 months after omentectomy. They were all multiparous females with the age over 40. Two patients showed multiple recurrence of hernia (total 2 and 3 times) and finally lost catheter (18.2%), while others continued CAPD without a recurrence after herniorraphy. It occurred in none of the patients who did not need any surgical intervention (126 patients) and in only 1 (14.3%) out of 7 patients in whom simple surgical correction without omentectomy was performed. The incidence also is higher when compared to previous reports in which omentectomy was performed preventively at the time of catheter implantation (9-24%). It may need to evaluate whether surgical omentectomy after occurrence of catheter dysfunction may provide more risk for incisional hernia than simple surgical correction without omentectomy or preventive omentectomy at the time of catheter implantation.