Update Narbenhernie Parastomale Hernie

Abstract

Parastomal herniation is a frequent complication when an artificial anus is constructed. As a tunnel through the abdominal wall is nonphysiological, there is an inherent trend to enlargement of the aperture with any artificial stoma. However, none of the technical modifications tried has proved reliable in reducing the incidence of parastomal herniation. The only clear-cut indications for repair are ileus and incarceration or serious problems with the colostomy bags. There are three basic methods of repair: fascial closure, stoma relocation and augmentation of the abdominal wall by nonabsorbable meshes, and any of the three can be combined in many ways. The first two techniques each have a recurrence rate of 40%-80%, and neither can therefore any longer be recommended for use in isolation. Only with the last technique of abdominal wall reinforcement it is possible to achieve a recurrence rate of under 20%. The best type of mesh and the optimal implantation technique are still under discussion.

Laparoscopic Repair of Parastomal Hernias: A Single Surgeon's Experience in 66 Patients

“…However, most studies dealing with the open repair also suffer from small patient numbers and do not allow any evaluation or even a recommendation of the most suitable technique. 5,[10][11][12][13][14][15] The same is true for the very recent description of the relocation of the stoma with a prophylactic mesh and the mesh-based repair of the original defect by Israelson, 27 implying the weakening of a second quadrant of the abdominal wall. Our primary goal, however, is preserving the stoma at its original site as long as possible, preventing weakening of further quadrants of the abdominal wall.…”

“…7 These disappointing results are based on the fact that parastomal and incision hernias represent a biologic disease rather than a simple mechanical rupture. 5,8,9 Therefore, only mesh-based techniques proved to be effective in terms of reducing recurrence rates to sometimes less than 10 percent at least in cases of incision hernias. [10][11][12][13][14][15] However, wound complications occur in up to 30 percent.…”

“…[Key words: Laparoscopy; Colostomy; Ileostomy; Parastomal hernia; Mesh] P arastomal hernias are common problems after ostomies. [1][2][3][4][5] The frequency is so high that sometimes it is no more regarded as a complication of the procedure itself. Patients suffering from parastomal hernias may develop acute problems, such as incarceration or obstruction, as well as difficulties with handling of the stoma, which may exclude these patients from social activities.…”

Parastomalis sérvek

“…10 Igaz, hogy ezt a nyílást a rajta keresztül vezetett bélkaccsal zárjuk, de a bélfal konzisztenciája egészen más, mint a musculofascialis rétegé. A mi szempontunkból nézve sokkal gyengébb környezeténél, könnyen megnyúlik a gondos kivarrás ellenére is.…”

Reparation und Prävention parastomaler Hernien mit PHSL-Netznach abdomino-perinealer Rektumexstirpation

“…Etwa ein Fünftel dieser Hernien bedarf wegen eines Ileus, einer Inkarzeration oder eines schwerwiegenden Problems bei der Versorgung des Stomas mit dem Kolostomiebeutel der operativen Korrektur [2,4,5,7,9, 12 ± 14]. Die Spätkomplikation wird manchmal durch die exzessive postoperative Gewichtszunahme des Patienten verursacht, aber nicht selten auch durch eine technisch unzureichende Anlage der Kolostomie.…”