Gernot Köhler1,2,3,4, Franz Mayer5, Helwig Wundsam6,7,8, Rudolf Schrittwieser9, Klaus Emmanuel6,7,8, Michael Lechner5. 1. Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria. gernot.koehler@bhs.at. 2. Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria. gernot.koehler@bhs.at. 3. Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria. gernot.koehler@bhs.at. 4. Department of Surgery, Paracelsus Medical University, Salzburg, Austria. gernot.koehler@bhs.at. 5. Department of Surgery, Paracelsus Medical University, Salzburg, Austria. 6. Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria. 7. Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria. 8. Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria. 9. Department of Surgery, Hospital Bruck an der Mur, Bruck an der Mur, Austria.
Abstract
BACKGROUND: Over the years, various open and laparoscopic approaches toward the repair of parastomal hernias (PSH) have been described. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures. METHODS: From January 1999 to January 2014, we assessed all cases of PSH repair performed at the three participating surgical departments in a retrospective analysis. The results were evaluated with regard to different surgical techniques focusing on complications and recurrences. RESULTS: One hundred and thirty-five individuals could be included in the analysis. They were operated on with eight different surgical techniques. Laparoscopic procedures were carried out in 46.7 % (63/135) of the cases. Median follow-up was 54 months (12-146 months). We found 44 cases of recurrence (32.6 %) and 24 (17.8 %) of the patients experienced perioperative complications and 12 of them needed to return to theater. Fourteen of the 135 patients (10.4 %) were operated as emergency cases which were associated with a mortality of 28.6 % (4/14). In case of elective PSH repair, no mortality occured. CONCLUSION: The results achieved by direct suture or the use of incised flat meshes for the repair of PSH were poor with these procedures having unacceptably high recurrence rates. With regard to the latter ostomy revision through three-dimensional funnel-shaped meshes and the laparoscopic sandwich technique showed the best results. Emergency procedures were linked to a dramatic increase in morbidity and mortality (p < 0.001).
BACKGROUND: Over the years, various open and laparoscopic approaches toward the repair of parastomal hernias (PSH) have been described. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures. METHODS: From January 1999 to January 2014, we assessed all cases of PSH repair performed at the three participating surgical departments in a retrospective analysis. The results were evaluated with regard to different surgical techniques focusing on complications and recurrences. RESULTS: One hundred and thirty-five individuals could be included in the analysis. They were operated on with eight different surgical techniques. Laparoscopic procedures were carried out in 46.7 % (63/135) of the cases. Median follow-up was 54 months (12-146 months). We found 44 cases of recurrence (32.6 %) and 24 (17.8 %) of the patients experienced perioperative complications and 12 of them needed to return to theater. Fourteen of the 135 patients (10.4 %) were operated as emergency cases which were associated with a mortality of 28.6 % (4/14). In case of elective PSH repair, no mortality occured. CONCLUSION: The results achieved by direct suture or the use of incised flat meshes for the repair of PSH were poor with these procedures having unacceptably high recurrence rates. With regard to the latter ostomy revision through three-dimensional funnel-shaped meshes and the laparoscopic sandwich technique showed the best results. Emergency procedures were linked to a dramatic increase in morbidity and mortality (p < 0.001).
Authors: Frederik Helgstrand; Jacob Rosenberg; Henrik Kehlet; Lars N Jorgensen; Pål Wara; Thue Bisgaard Journal: Dis Colon Rectum Date: 2013-11 Impact factor: 4.585
Authors: J Moreno-Matias; X Serra-Aracil; A Darnell-Martin; J Bombardo-Junca; L Mora-Lopez; M Alcantara-Moral; P Rebasa; I Ayguavives-Garnica; S Navarro-Soto Journal: Colorectal Dis Date: 2008-05-03 Impact factor: 3.788
Authors: Nicholas Jonathan Slater; Bibi M E Hansson; Otmar R Buyne; Thijs Hendriks; Robert P Bleichrodt Journal: J Gastrointest Surg Date: 2011-03-01 Impact factor: 3.452
Authors: Elisa Mäkäräinen-Uhlbäck; Jaana Vironen; Ville Falenius; Pia Nordström; Anu Välikoski; Jyrki Kössi; Aristotelis Kechagias; Maija Kalliala; Anne Mattila; Tuomo Rantanen; Tom Scheinin; Pasi Ohtonen; Tero Rautio Journal: World J Surg Date: 2021-02-09 Impact factor: 3.352