When to Start Peritoneal Dialysis After Hernia Repair
Peritoneal dialysis should be restarted 4-6 weeks after elective hernia repair to allow adequate wound healing, though low-volume supine dialysis can be initiated earlier (48 hours post-operatively) if dialysis cannot be delayed. 1, 2
Optimal Timing: Elective Hernia Repair Before PD Initiation
Wait 4-6 weeks after hernia repair before starting full-volume peritoneal dialysis to ensure complete wound healing and minimize risk of hernia recurrence, dialysate leak, and surgical site complications. 1
This approach eliminates the risk of hernia-related PD failure and allows for proper tissue healing before exposing the repair to increased intra-abdominal pressure from dialysate. 1
Tension-free mesh repair techniques (anterior tension-free mesh or plug repair) are safe and effective in PD patients, with low recurrence rates when adequate healing time is allowed. 1
Early Restart Protocol: When Dialysis Cannot Be Delayed
If you cannot wait 4-6 weeks due to urgent dialysis needs, use this graduated approach:
Days 1-2 Post-Operatively
- Keep patient off dialysis for the first 48 hours after hernia repair to allow initial wound stabilization. 2
Weeks 1-2: Low-Volume Supine Phase
- For CAPD patients: Start intermittent PD (IPD) 3 times per week for 10 hours per day using reduced fill volumes of 1.0-1.5 L (compared to standard 2.0-3.0 L). 2
- For CCPD patients: Use 1 week of IPD followed by nocturnal IPD. 2
- Keep patient strictly supine during exchanges to reduce intra-abdominal pressure and minimize leak risk. 3, 2
Weeks 3-4: Volume Escalation
- Gradually increase to 5 exchanges of low-volume (1.0-1.5 L) CAPD for CAPD patients. 2
- Continue nocturnal IPD for CCPD patients. 2
Week 5 and Beyond
- Return to pre-surgery prescription volumes (2.0-3.0 L based on body surface area) by week 4-5. 2
Metabolic Monitoring During Reduced Dialysis
- Expect serum creatinine to increase from approximately 673 μmol/L to 968 μmol/L during low-volume IPD. 2
- Monitor serum potassium closely (expect increase from ~3.4 to 4.7 mmol/L), though hyperkalemia is uncommon with this protocol. 2
- Most patients tolerate this graduated approach without requiring interim hemodialysis. 2
Alternative Strategy: Simultaneous Repair and Catheter Placement
Simultaneous hernia repair and PD catheter implantation is a safe alternative with high catheter survival rates (96% at median 37 months follow-up) and no hernia recurrences when performed by experienced surgeons. 4
Daily flushing can be started on postoperative days 1-3 with this approach. 4
This strategy is particularly useful for patients with pre-existing hernias who need to start PD, avoiding the need for staged procedures. 4
Critical Pitfalls to Avoid
Do not use full 2-3 L volumes immediately after hernia repair — this dramatically increases leak and hernia recurrence risk. 3, 2
Do not allow upright positioning until tolerating at least 1.5 L volumes for 48 hours to minimize intra-abdominal pressure on the fresh repair. 3
Do not ignore pre-existing hernias — all hernias should ideally be repaired before or simultaneously with PD catheter placement, as irreparable hernias are an absolute contraindication to PD. 1
Stop sirolimus several days before hernia repair if the patient is a transplant recipient, as it significantly impairs wound healing and increases risk of wound dehiscence and hernia recurrence. 5