Risk factors for recurrence of paraumbilical hernia in End-Stage Renal Failure patients on Peritoneal dialysis

Abstract

Objectives: To study the risk factors associated with recurrent paraumbilical hernia in End-Stage Renal Failure (ESRF) patients on Peritoneal Dialysis (PD) Patients & Methods: Retrospective analysis of ESRF and PD patients who had undergone paraumbilical hernia repair in the period of May 2011 to May 2020 in Hong Kong West Cluster was performed. In total 38 patients were identified, including elective or emergency repair of paraumbilical hernia in Queen Mary Hospital or Tung Wah Hospital. Patients characteristics, operative details and clinical outcome were evaluated. Results: Median follow-up for the cohort was 30 months. Size of defect of the paraumbilical hernia ranges from 1cm to 4cm. 16 patients (42.1%) had mesh repair with either Prolene mesh or biological mesh, 22 patients had primary closure (57.9%). 6 patients in the primary repair group had recurrent hernia (18.8%) while none had recurrence in the mesh repair group. The higher risk of recurrence in primary repair group was statistically significant (p=0.03). The complication rates for both group of patients are very low. Further statistical analysis with t-test, Chi-square test and Fisher's exact test failed to show other significant risk factors for recurrence, including age (p=0.587), size of defect (p=0.829), duration of PD (p=0.269) and diabetes mellitus (p=0.239). Conclusion: Our study echoes with current evidence that the use of mesh for paraumbilical hernia repair carries lower risk of recurrence. Mesh repair for paraumbilical hernia in ESRF patients on PD provide a better clinical outcome without an increased risk of wound complication.