Indication for the surgical management of parastomal hernias

The Longtan Modification: An Effective and Economical Surgical Innovation for Parastomal Hernia Post-Intraperitoneal Sigmoidostomy

PURPOSE

This study was designed to introduce a new surgical innovation, referred to as the "Longtan modification," for cases with parastomal hernia (PSH) following intraperitoneal sigmoidostomy, and to assess the safety and feasibility of this procedure.

METHODS

Between January 2013 and June 2016, a total of 26 consecutive cases with PSH successfully underwent this procedure. The patient demographics, surgical outcomes, stoma-related complications, and the stoma function were collected and analyzed.

RESULTS

Mean diameter of the hernia ring was 7.6 cm, mean operation time was 94.2 minutes, and mean intraoperative blood loss was 18.0 mL. The mean period of postoperative hospitalization was 4.4 days while the mean hospitalization cost was only $3,750 USD. There were no severe complications such as postoperative hemorrhage, ischemic necrosis, peritoneal infection, or intestinal obstruction, although one case suffered from postoperative infection at the site of incision. None of the cases had a recurrence of PSH during the follow-up period. In addition, the stoma functioned efficiently and appropriately following the Longtan modification.

CONCLUSION

Overall, the Longtan modification appears to be an effective and economical surgical innovation for cases with PSH following intraperitoneal sigmoidostomy.

Onlay parastomal hernia repair with cross-linked porcine dermal collagen biologic mesh: long-term results

PURPOSE

The optimal technique and mesh type for parastomal hernia repair have yet to be ascertained. Biologic meshes have been advocated in parastomal hernia repair due to purported resistance to infection in contaminated fields. The aim of this study was to evaluate the effectiveness of additionally cross-linked acellular porcine dermal collagen mesh (Permacol) for onlay parastomal hernia repair.

METHODS

A retrospective review of case notes, and abdominal CT scans when available, was performed for consecutive patients who had a parastomal hernia repaired between January 2007 and May 2010. All hernias were repaired with onlay placement of the biologic mesh. Hernias were classified according to the Moreno-Matias classification where CT scans were available.

RESULTS

Over a 34-month period, 30 consecutive patients, median age 74 years, 17 female, underwent parastomal hernia repair using onlay biologic mesh. There were 23 paracolostomy and seven paraileostomy hernias. The hernia was primary in 26 patients. Pre-operative CT scans were available in 18 patients (Moreno-Matias Type 1 = 1, Type 2 = 4, Type 3 = 13). There was one perioperative death, and 29 patients were available for follow-up, and median duration of follow-up (either CT or clinical) was 36 months (range 3-79). Twenty-six patients developed recurrence of the parastomal hernia (89.6%), and median time to recurrence was 10 months (range 3-72),with Moreno-Matias Type 1 = 0, Type 2 = 4, Type 3 = 14, unknown = 8. Fifteen out of 26 patients have had repairs of the recurrence using a variety of techniques. Of these, 10 patients have had further recurrence.

CONCLUSION

Onlay repair of parastomal hernia with cross-linked porcine dermal collagen biologic mesh reinforcement has poor long-term outcomes with unacceptably high recurrence rates and should not be performed.

New minimally invasive technique of parastomal hernia repair - methods and review

INTRODUCTION

Parastomal hernia is described as the most common complication in patients with ostomy. It is reported that its incidence varies from 3% to 39% for colostomies and 0 to 6% for ileostomies. Surgical repair remains the treatment of choice. There are three types of surgical treatment - fascial repair, stoma relocation and repair using prosthetic mesh via a laparoscopic or open approach. Recently there have been several meta-analyses and systematic reviews aiming to compare the results of surgical treatment, and the authors agreed that the quality of evidence precludes firm conclusions.

AIM

To describe the novel concept of parastomal hernia repair - HyPER/SPHR technique (hybrid parastomal endoscopic re-do/Szczepkowski parastomal hernia repair) and its early results in 12 consecutive cases.

MATERIAL AND METHODS

Twelve consecutive patients were operated on due to parastomal hernia using the new HyPER hybrid technique between June 2013 and May 2014. The patients' condition was evaluated during the perioperative period, 6 weeks and then every 3 months after surgery.

RESULTS

After 6 weeks of follow-up we have not observed any mesh-related complications. All 12 patients were examined 3 months and 6 months after repair surgery for evaluation. No recurrence, stoma site infection or stoma-related problems were found. None of the patients complained of pain and none of them needed to be hospitalized again. Reported quality of life on a 0-10 scale after 6 weeks of follow-up was 8 (range: 7-10).

CONCLUSIONS

The HyPER procedure for treatment of parastomal hernias proposed by the authors is a safe and feasible surgical technique with a high patient satisfaction rate and a low number of complications. The hybrid procedure seems to be a promising method for parastomal hernia repair.