Retroperitoneal hematoma in a peritoneal dialysis patient on oral anticoagulant treatment.

Abstract

operative day. Peritoneal dialysis was started 1 month after surgery owing to intolerance to the dialysate. After 15 months of follow-up, the catheter maintained patency without migration, catheter tract infection, or peritonitis. There was no abdominal wall hernia found during this period. The guidelines of the International Society for Peritoneal Dialysis (ISPD) recommend that any abdominal wall hernia should be repaired before PD is started (2). According to the study by García–Ureña et al., abdominal wall hernias develop in 17.2% of patients that receive PD, and 73% are found before PD. Inguinal hernias account for 26.9% of these patients (3). Laparoscopic PD catheter placement has been introduced widely owing to the benefits in reducing mechanical complications (4). It is worthwhile performing concomitant laparoscopic TEP hernioplasty and PD catheter placement, which not only benefits PD catheter fixation but also promises hernia repair, rapid patient recovery, and wound size reduction. In this case, the TEP approach made it more secure theoretically than the conventional open method in PD patients owing to the design of internal fixation. Although most PD patients have poor general performance and limited choices of surgical procedures that include PD catheter placement and hernioplasty, laparoscopic concomitant procedures can be an alternative choice for some suitable patients. In this case, concomitant hernioplasty and PD catheter placement was safe, effective, and worthwhile.