Dieter Berger1, Marc Bientzle. 1. Department of Surgery, Stadtklinik, Baden-Baden, Germany. d.berger@klinikum-mittelbaden.de
Abstract
INTRODUCTION: The repair of parastomal hernias represents a surgical problem with high complication and failure rates. A basic principle is the necessity of mesh-based techniques. The study was performed to evaluate a laparoscopic approach, primarily based on the intraperitoneal on lay mesh technique. METHODS: Sixty-six patients with a symptomatic parastomal hernia were enrolled in the prospective study between November 1999 and February 2006. After complete adhesiolysis, the mesh was introduced to cover the fascial defect of the hernia and the original midline incision. In special cases, a two-mesh technique was used. First, an incised mesh was placed around the stoma sling. The second mesh was used to cover the abdominal wall with the first mesh; the stoma sling was placed between the two meshes for at least 5 cm. RESULTS: The two-mesh technique proved to be superior in terms of recurrence rate especially in cases with a lateral fascial defect. CONCLUSIONS: The laparoscopic repair of parastomal hernias is a surgically challenging procedure with promising results when using the two-mesh technique. Therefore, two meshes should be used in all cases of parastomal hernias. Polyvinylidene fluoride was revealed to be the most suitable material for the sandwich repair in terms of possible ingrowth and infection resistance.
INTRODUCTION: The repair of parastomal hernias represents a surgical problem with high complication and failure rates. A basic principle is the necessity of mesh-based techniques. The study was performed to evaluate a laparoscopic approach, primarily based on the intraperitoneal on lay mesh technique. METHODS: Sixty-six patients with a symptomatic parastomal hernia were enrolled in the prospective study between November 1999 and February 2006. After complete adhesiolysis, the mesh was introduced to cover the fascial defect of the hernia and the original midline incision. In special cases, a two-mesh technique was used. First, an incised mesh was placed around the stoma sling. The second mesh was used to cover the abdominal wall with the first mesh; the stoma sling was placed between the two meshes for at least 5 cm. RESULTS: The two-mesh technique proved to be superior in terms of recurrence rate especially in cases with a lateral fascial defect. CONCLUSIONS: The laparoscopic repair of parastomal hernias is a surgically challenging procedure with promising results when using the two-mesh technique. Therefore, two meshes should be used in all cases of parastomal hernias. Polyvinylidene fluoride was revealed to be the most suitable material for the sandwich repair in terms of possible ingrowth and infection resistance.