The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position.
Parastomal herniation is a very frequent complication in enterostomy. The therapeutic strategy consists of three approaches: local fascial repair, relocation of the stoma, and a variety of more elaborate procedures, many of which also involve the use of nonabsorbable meshes. Despite this multitude of available techniques, recurrence rates are high, and long-term complications, especially after mesh implantation, are frequent. In order to improve operative results, we would suggest that a parastomal hernia be treated like a subtype of incisional herniation and that methods be employed that have proved to be effective in this situation. A midline approach allows the operation to be performed under practically sterile conditions. The reinforcing mesh is placed in a sublay position, using a combined intraperitoneal and epifascial preparation. Any direct contact between mesh and intestines is thus avoided. A new type of mesh with substantially reduced polypropylene content decreases the occurrence of both early and late complications.
Kasperk
R
R
Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Klinge
U
U
Schumpelick
V
V
D000009:Abdominal Muscles / Q000601:surgery; D020341:Absorbable Implants; D004766:Enterostomy / Q000009:adverse effects*; D004867:Equipment Design; D000071938:Fasciotomy; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010537:Peritoneum / Q000601:surgery*; D011126:Polypropylenes; D016062:Porosity; D013499:Surface Properties; D013526:Surgical Mesh; D013536:Suture Techniques; D013537:Sutures / Q000145:classification
D011126:Polypropylenes