title: Lateral repair of parastomal hernia.
abstract: BACKGROUND
  Parastomal hernia is a common complication of stoma construction. Although the majority of patients are asymptomatic, about 10% require surgical correction.
  
  
  OBJECTIVE
  We describe a new surgical approach for the repair of parastomal hernias, which avoids both the need for laparotomy and stoma mobilization.
  
  
  METHODS
  Nine patients (4 female) with parastomal hernia underwent surgical repair. Median age was 55 years (range 38-73 years). There were 8 para-ileostomy herniae and one paracolostomy hernia. A lateral incision was made approximately 10 cm from the stoma, and carried down to the rectus sheath. The dissection was carried medially towards the stoma, and around the defect in the abdominal musculature. The hernia sac was excised when possible and the fascial defect closed with non-absorbable, monofilament suture. A polyprolene mesh was placed round the stoma by making a slit in the mesh. The skin was closed with subcuticular monofilament absorbable suture.
  
  
  RESULTS
  All patients returned to normal diet on the first postoperative day, and were discharged from hospital within 72 h. There were no wound infections, and no recurrences after a median follow up of 6 months (range 3-12 months).
  
  
  CONCLUSIONS
  The technique we describe is simple and avoids the need of laparotomy. The mucocutaneous junction of the stoma is not disturbed, reducing the risk of contamination of the mesh, stenosis or retraction of the stoma. Grooving of the stoma and difficulty in fitting appliances is avoided because the wound is not placed near the mucocutaneous junction. This approach may be superior to other mesh repairs for parastomal hernia.
authors: Department of Surgery, Division of Coloproctology, University Hospital Nottingham, Nottingham, UK. shwan1st@hotmail.com
authors: S N
authors: SN
authors: Amin
authors: N C
authors: NC
authors: Armitage
authors: J F
authors: JF
authors: Abercrombie
authors: J H
authors: JH
authors: Scholefield
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods; D004766:Enterostomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013526:Surgical Mesh; D013536:Suture Techniques