BACKGROUND: Management of the parastomal hernia represents a common clinical dilemma for both the surgeon and patient. Once established, these defects are notoriously difficult to treat. Although most parastomal hernias can be managed nonoperatively, approximately 30% will require intervention secondary to complications such as obstruction, pain, bleeding, poorly fitting appliances, or leakage. Overall complication rates of up to 88%, combined with a growing body of literature citing decreased patient morbidity and improved outcomes with laparoscopic tension-free mesh repair of ventral hernias, have led many surgeons to apply these techniques to this difficult problem. METHODS: This was a retrospective review of 21 consecutive patients who underwent laparoscopic repair of their parastomal hernias with ePTFE mesh. RESULTS: Nine (43%) were ileal conduits, seven (33%) were ileostomies, and five (24%) were colostomies. Eight patients had undergone prior hernia repair. Follow-up ranges from 1 to 36 months (average 14 months). There has been one recurrence (5%). Other complications included laparoscopic re-operation for obstruction of a urinary conduit (n=1), mesh removal for infection (n=2), Clostridium Difficile colitis (n=1), pneumonia (n=2), renal failure (n=1), surgical site infection (n=1), and bowel obstruction at a site remote from the hernia repair (n=2). CONCLUSION: The laparoscopic approach to parastomal hernias is a new technique that offers many potential advantages over conventional open repairs. Based on our initial experience, this repair seems to be associated with a low recurrence rate.
BACKGROUND: Management of the parastomal hernia represents a common clinical dilemma for both the surgeon and patient. Once established, these defects are notoriously difficult to treat. Although most parastomal hernias can be managed nonoperatively, approximately 30% will require intervention secondary to complications such as obstruction, pain, bleeding, poorly fitting appliances, or leakage. Overall complication rates of up to 88%, combined with a growing body of literature citing decreased patient morbidity and improved outcomes with laparoscopic tension-free mesh repair of ventral hernias, have led many surgeons to apply these techniques to this difficult problem. METHODS: This was a retrospective review of 21 consecutive patients who underwent laparoscopic repair of their parastomal hernias with ePTFE mesh. RESULTS: Nine (43%) were ileal conduits, seven (33%) were ileostomies, and five (24%) were colostomies. Eight patients had undergone prior hernia repair. Follow-up ranges from 1 to 36 months (average 14 months). There has been one recurrence (5%). Other complications included laparoscopic re-operation for obstruction of a urinary conduit (n=1), mesh removal for infection (n=2), Clostridium Difficilecolitis (n=1), pneumonia (n=2), renal failure (n=1), surgical site infection (n=1), and bowel obstruction at a site remote from the hernia repair (n=2). CONCLUSION: The laparoscopic approach to parastomal hernias is a new technique that offers many potential advantages over conventional open repairs. Based on our initial experience, this repair seems to be associated with a low recurrence rate.
Authors: Wissam J Halabi; Mehraneh D Jafari; Joseph C Carmichael; Vinh Q Nguyen; Steven Mills; Michael Phelan; Michael J Stamos; Alessio Pigazzi Journal: Surg Endosc Date: 2013-07-09 Impact factor: 4.584