Abdominal wall hernia repair in patients with chronic renal failure and a dialysis catheter.

This paper describes the incisional hernia repair technique carried out on 50 patients with chronic renal insufficiency requiring continuous ambulatory peritoneal dialysis. The technique involved fixing a polypropylene mesh prosthesis to the deep face of lateral incisions into the aponeurosis of the rectus abdominis muscle. Under general or epidural anaesthesia the old scar was resected and the hernial sac dissected, care being taken not to open the peritoneum. At 5 cm from either side of the hernia margin, the aponeurosis was incised longitudinally and the adjacent muscle separated. The mesh was sutured to the deep face of the aponeurosis, covering the hernial defect. A Tenckhoff catheter was left in the abdominal cavity. Peritoneal dialysis was given to all 50 patients in the immediate postoperative period, with no leaking of the dialysis fluid. One year later there has been no recurrence. Prosthetic mesh fixed to the deep face of the abdominal aponeurosis at incisions lateral to the hernia margins, without opening the peritoneum, is an effective treatment of incisional hernia repair for patients on peritoneal dialysis and allows early institution of dialysis.