Laparoscopic parastomal hernia repair

Abstract

Repair of parastomal represents a significant challenge for the hernia surgeon. Repair of these hernias is indicated because of an ill-fitting appliance, cosmetic deformity, inability to maintain proper hygiene and complications from the hernia itself such as incarceration or strangulation. Recent reports in the literature have shown that primary fascial repair can occur in 46% of patients and relocation of the stoma is associated with a 40% recurrence rate. For this reason, the use of polypropylene mesh has been applied to this repair. The recurrence rate with this open technique will still incur a failure rate of 20-29%. Additionally there are other complications such as obstruction, fistulization or mesh erosion with this biomaterial. The laparoscopic approach to this hernia may offer a new choice for this difficult problem. We have used ePTFE to repair 12 parastomal hernias with three different approaches. There have been eight colostomy, two ileostomy and two urostomy hernias. Follow-up ranges from 3-39 months (average 20 months). There has been one recurrence that required two repairs (8%). Other complications included enterotomy (one patient), ileus (one), seroma (one), and death from postoperative aspiration (one). The laparoscopic repair of parastomal hernias appears to be a promising technique for this complex dilemma.

Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients

“…However, it must be realized that these results are based mainly on case reports and small retrospective series with insufficient follow-up evaluation and quality for definitive conclusions to be drawn on these important issues. The only prospective study addressing the topic of perioperative complication rates reports on only 12 patients, and although the low recurrence rate of only 8% is promising as compared with other techniques, the perioperative complication rate of 25% and one fatality may deter others from adopting this technique [11]. Therefore, the current study was undertaken to determine the feasibility and safety of laparoscopic parastomal hernia repair specifically and prospectively.…”

“…However, various authors have published contradictory results on this issue [6,11,14,15,18]. This may be explained partly by the differing operative techniques (open or laparoscopic), types of mesh (polypropylene, PTFE, or a combination), and positions of the mesh (intraperitoneal, preperitoneal, or onlay) used [3].…”

“…One of the issues raised is the relatively high perioperative complication and mortality rates reaching 65% and 8%, respectively [11,13,15,18]. Recently, we have developed and described a laparoscopic technique for repairing parastomal hernias with a prosthetic mesh [8].…”

Tratamiento laparoscópico de la hernia paraestomal: indicaciones y manejo en la actualidad

“…En esta no hay fibrosis con la pared abdominal posterior, y puede favorecer la herniación. Para evitar este tercer problema, LeBlanc ha descrito el uso de dos mallas de ePTFE variando la orientación de la fenestración, pero no puede evitar la principal zona débil, el agujero central donde ambas mallas se superponen 16 . El error que le lleva a complicar y encarecer la cirugía es el de usar siempre un mismo tipo de malla y no buscar una prótesis que tenga una solapa sobre una de las hojas, que se superponga a la inferior y evite una zona parietal sin fibrosis.…”

Laparoscopic Hernia Repair

“…The reported incidence of parastomal hernias varies from 28% in ileostomies to 56% in colostomies (Carne et al, 2003;LeBlanc et al, 2005;Rieger et al, 2004). A parastomal hernia is more likely to occur when the stoma emerges through the semilunar line rather than the rectus sheath.…”