title: Acellular dermal matrix (AlloDerm): new material in the repair of stoma site hernias.
abstract: Parastomal hernias are a common complication after ileostomy or colostomy formation and can lead to complications, such as intestinal obstruction and strangulation. When a parastomal hernia presents, repair of the defect can pose a challenge to the surgeon to choose a repair that both reduces complications and recurrence rates. We present three cases of parastomal hernia repair using acellular dermal matrix (AlloDerm) as reinforcement to the primary hernia repair. We prospectively followed three patients who presented with parastomal hernia after ostomy formation in 2001-2002. The patients underwent repair of the parastomal hernia using primary fascial repair with reinforcement using AlloDerm as an on-lay patch. Two patients were followed for 6 months and 1 year, respectively, and remained hernia-free. One patient presented 8 months later with symptoms of intestinal obstruction that were relieved by nasogastric tube decompression and bowel rest. The patient subsequently returned 3 months later with intestinal obstruction and recurrent parastomal hernia that necessitated an operation for relocation of the stoma and repeat hernia repair. Repair of parastomal hernias using AlloDerm acellular dermal matrix as a substitute for a synthetic graft showed resilience to infection and, more importantly, tolerated exposure in an open wound without having to be removed. Larger studies with longer follow-up are needed to see if this material reduces the incidence of hernia recurrence.
authors.affiliation: Division of General Surgery, Abington Memorial Hospital, Abington, Pennsylvania, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Kish
authors.forename: Brian R
authors.initials: BR
authors.lastname: Buinewicz
authors.forename: Jon B
authors.initials: JB
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D003094:Collagen / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects / Q000379:methods; D003424:Crohn Disease / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*; D013718:Tensile Strength; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: C440568:Alloderm; D003094:Collagen