I have a patient with bilateral patent processus vaginalis which was accidentally discovered while performing urgent-start PD and the caregiver placed him in an upright position which led to scrotal edema. The finding was confirmed by CT peritoneography. He underwent bilateral inguinal herniorrhaphy and currently shifted to hemodialysis. Is it safe to resume PD 4 weeks post-surgery? When resuming PD, should I start low fill volumes and shorter dwell time? Can I placed him right away to CAPD? Thank you

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MARY ROSE BISQUERA, Doctor/MD from Philippines asked
I have a patient with bilateral patent processus vaginalis which was accidentally discovered while performing urgent-start PD and the caregiver placed him in an upright position which led to scrotal edema. The finding was confirmed by CT peritoneography. He underwent bilateral inguinal herniorrhaphy and currently shifted to hemodialysis. Is it safe to resume PD 4 weeks post-surgery? When resuming PD, should I start low fill volumes and shorter dwell time? Can I placed him right away to CAPD? Thank you

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Susie Hu, MD from USA April 19, 2021

It should be more than enough to return to PD by 4 weeks.  I many cases, we are able to keep patients on PD after surgery after holding for a few days.  If the patient has residual renal function, you maybe able to wait even longer to hold PD.  Then you may start low volume dialysis (1 L) and withhold a day dwell if you are starting soon after surgery, then can resume full volumes generally after ~4 weeks. 
See reference: Shah H, Chu M, Bargman JM. Perioperative management of peritoneal dialysis patients undergoing hernia surgery without the use of interim hemodialysis. Perit Dial Int. 2006 Nov-Dec;26(6):684-7. PMID: 17047236.

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