Multimedia article. Laparoscopic repair of parastomal hernia using a porcine dermal collagen (Permacol) implant.
BACKGROUND
Surgical repair of parastomal hernias is usually performed through a laparotomy (stoma translocation) or a peristomal incision (mesh repair). Laparoscopic approach may minimize the risks of mesh infection and, thus, represents an attractive alternative. Permacol (Tissue Science Laboratories plc, Aldershot, Hampshire, U.K.) is a new biomaterial implant, which combines the strength and biocompatibility.


METHODS
Case 1: A 67-year-old patient presented with paracolostomal hernia causing discomfort and intermittent obstructive episodes, 12 months after a proctectomy for severe radiation proctitis. Case 2: A 74-year-old patient presented with a symptomatic paracolostomal hernia 18 years after abdominoperineal amputation.


RESULTS
Both procedures took less than 120 minutes. Patients were started on a liquid and solid diet on postoperative Day 1 and discharged to home on the sixth and seventh postoperative days. There was no evidence of hernia recurrence or mesh-related complication at the time of last follow-up: nine months and three months postoperatively.


CONCLUSIONS
Compared with the traditional open technique, the technique described has two potential benefits: 1) the laparoscopic approach provides a means to avoid operating in a contaminated field and may reduce the risks of mesh infection; and 2) the use of a biologic graft may minimize the incidence of synthetic mesh-related complications, such as erosion into viscera and fistula. The use of biologic implants in this indication seems promising and deserves further evaluation.
Inan
Ihsan
I
Department of Surgery, University Hospital Geneva, Geneva, Switzerland. ihsan.inan@hcuge.ch
Gervaz
Pascal
P
Hagen
Monica
M
Morel
Philippe
P
D000368:Aged; D000818:Animals; D001672:Biocompatible Materials; D003094:Collagen; D003125:Colostomy / Q000009:adverse effects*; D005500:Follow-Up Studies; D006547:Hernia / Q000209:etiology; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods*; D013552:Swine; D014183:Transplantation, Heterologous
D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen