Abdominal wall incisional hernia repair improves respiratory function: results after 3 years of follow-up.

PURPOSE: Hernias severely impact patient quality of life (QoL), and 80% of patients require a surgical operation. Moreover, hernias are responsible for respiratory function alterations. This study aims to investigate the postoperative alterations in respiratory function after open ventral hernia repair in patients with incisional hernia. METHODS: Patients operated on at the Policlinico "Paolo Giaccone" at Palermo University Hospital between January 2015 and December 2016 were identified in a prospective database. Fifty-one patients were enrolled in the study. The respiratory outcome measures used were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF) and PEF percentage (%PEF). The timepoints at which the parameters listed were assessed were t0, 1 week before the surgical operation; t1, 12 months later; and t2, 3 years later. RESULTS: The difference between mean preoperative and postoperative PEF was significant [t0 4.32 (4.03-7.92), t1 6.7 (4.27-8.24) with p = 0.012 and t2 6.5 (4.25-8.21) with p = 0.026]. The %PEF increased from 75% preoperatively to 87% at t1 (p = 0.009) and to 85% at t2 (p = 0.03). No differences were found in the comparison of pre- and postoperative FVC, FEV1 or FEV1/FVC ratio. CONCLUSION: The improvement in respiratory measures suggests the importance of abdominal wall restoration to recover functional activity of respiratory function.

Improved patient/technique survival and peritonitis rates in patients treated with automated peritoneal dialysis when compared to continuous ambulatory peritoneal dialysis in a Mexican PD center.

Since its introduction in Mexico in 1998, the use of automated peritoneal dialysis (APD) has grown steadily and now 35% of Mexican patients are being treated with it. Peritonitis continues to be the most important infectious cause of drop out in peritoneal dialysis (PD) programs and naturally has an impact on technique survival. The objective of this study was to compare patient and technical survival as well as peritonitis rates in APD vs continuous ambulatory peritoneal dialysis (CAPD) in our hospital PD program. We included all patients who initiated therapy between January 2003 and December 2005. Data at the beginning of therapy, causes of end-stage renal disease, gender, age, dialysis modality, drop out reasons, as well as peritonitis rate and date of presentation of first peritonitis event were collected and analyzed. For Kaplan-Meier survival analysis, patient status (alive, dead, or lost to follow up) at December 2005 was used as the observational end point. Modality differences were analyzed using a Cox regression model. A total of 237 patients were evaluated: 139 on CAPD and 98 on APD. The median age was 62 years on CAPD and 59 years on APD (P<0.031), and the percentage of diabetics was, respectively, 77 and 70% (P=NS). The CAPD drop out causes were death (57%), transfer to HD (29%), and other causes (16%), whereas in APD, 62% were due to death, 24% to transfer to HD, and 14% to other causes. APD/CAPD patient survival for year 1, 2, and 3 was 82/62, 62/49, and 56/42%, respectively. In conclusion, both therapies are considered good renal replacement therapy options in our hospital, but APD is the most attractive one as demonstrated by the positive results presented here.