腹腔鏡置放腹膜透析管合併全腹膜外疝氣修補術之案例報告與文獻回顧

張乃文¹、楊旻鑫^1,2

¹中山醫學大學附設醫院 泌尿科， ²醫學研究所

Combined Laparoscopic Peritoneal Dialysis Catheter Placement and Total Extraperitoneal Hernioplasty: a case report and literature review

Nai-Wen Chang¹, Min-Hsin Yang^1,2

Department of Urology¹, and Institute of Medicine², Chung Shan Medical University Hospital, Taichung, Taiwan

Introduction: We presented a case of perioperative finding of left inguinal hernia when laparoscopy examination and we performed total extraperitoneal hernioplasty (TEP) following laparoscopic peritoneal dialysis (PD) catheter by Versa step technique.

Case presentation: A 63-year-old man had history of chronic kidney disease stage 4 progression to stage 5 with uremic symptoms, coronary artery disease with triple vessel disease, congestive heart failure with reduced ejection fraction, hypertension and type 2 diabetes mellitus. The patient started hemodialysis due to uremic status and recurrent pleural effusions. Then, he accepted PD and received PD catheter placement. During laparoscopy examination, right direct type inguinal hernia was noted. Therefore, we performed TEP hernioplasty following laparoscopic PD catheter placement by Versa step technique.

Discussion: It’s recommended to repair abdominal hernias before starting PD. Previous study showed that 17.2% of PD patients develop hernias, with 73% diagnosed pre-PD, and 26.9% are inguinal hernias. Combining laparoscopic PD catheter placement with TEP hernioplasty offers multiple benefits, including improved hernia repair, faster recovery and smaller wounds. TEP, characteristic of pre-peritoneal fixation, is considered more secure than the conventional open method. Although PD patients face limitations in surgical options, this combined procedure is effective and safe for suitable patients. We maintained HD and started PD with low volume dialysate. The PD course was smooth and the catheter maintained patency without migration or infection.

Conclusion: TEP following laparoscopic PD catheter placement can be performed to prevent additional operations. The procedure makes patients benefit from PD treatment and prevent complications.