title: Outcome of parastomal hernia repair with and without midline laparotomy.
abstract: BACKGROUND
  Surgical options for parastomal hernia (PSH) repair are primary fascial, mesh repair, and relocation with or without midline laparotomy. Overall, recurrence rates are higher after fascial repairs than after relocation. However, stoma relocation may require a midline laparotomy with higher associated morbidity. The aim of this study was to assess the outcome of PSH repair with relocation with or without a midline laparotomy.
  
  
  METHODS
  All patients who underwent PSH repair with relocation were identified from a clinical database. Data were collected by retrospective review of medical records including patient demographics, presenting symptoms, predisposing factors, type of surgery, postoperative complications, recurrence, and follow-up. Patients were divided into two subgroups, with or without a midline laparotomy. In patients without a laparotomy, the stoma was intraperitoneally mobilized, passed behind the abdominal wall, and delivered and matured through a premarked stoma site, across the midline.
  
  
  RESULTS
  Between 1992 and 2001, a total of 27 patients underwent PSH repair with relocation of the stoma to the opposite side of the abdominal wall. Of these, the operation was performed without a midline laparotomy in 11 patients (41%). There were no significant differences in age, gender, body mass index, and the duration of hernia between the non-laparotomy and laparotomy groups. Prior abdominal surgery was recorded for 3 patients in the group without a laparotomy and for 9 patients in the group with a laparotomy (p=NS). Although not quantified, patients in the non-laparotomy group were less likely to have significant intraabdominal adhesions. Conversely, patients in the laparotomy group had more advanced adhesions. The operative time was longer in the group with a laparotomy than in the group without [96.8 (50-220) minutes vs. 123.9 (45-360) minutes; (p=NS)], and the mean hospital stay was significantly less in patients without vs. with a laparotomy [5.5 (SD=1.6) days vs. 9.5 (SD=3.8) days, respectively; (p<0.05)]. There was only one recurrence in the group without a laparotomy compared to 3 in the group with a laparotomy. The mean follow-up periods were 36.8 and 56.6 months in the groups without and with a laparotomy, respectively. The postoperative complications included wound infection that occurred in 3 patients in each group.
  
  
  CONCLUSIONS
  PSH repair with relocation without laparotomy was associated with a significantly shorter hospital stay, possibly due to the lack of a midline abdominal wound. It may not be feasible in patients with significant intraabdominal adhesions.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Baig
authors.forename: J A
authors.initials: JA
authors.lastname: Larach
authors.forename: S
authors.initials: S
authors.lastname: Chang
authors.forename: C
authors.initials: C
authors.lastname: Long
authors.forename: E G
authors.initials: EG
authors.lastname: Weiss
authors.forename: J J
authors.initials: JJ
authors.lastname: Nogueras
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054047:Surgical Stomas; D016896:Treatment Outcome