title: Laparoscopic parastomal hernia repair.
abstract: BACKGROUND
  Management of the parastomal hernia represents a common clinical dilemma for both the surgeon and patient. Once established, these defects are notoriously difficult to treat. Although most parastomal hernias can be managed nonoperatively, approximately 30% will require intervention secondary to complications such as obstruction, pain, bleeding, poorly fitting appliances, or leakage. Overall complication rates of up to 88%, combined with a growing body of literature citing decreased patient morbidity and improved outcomes with laparoscopic tension-free mesh repair of ventral hernias, have led many surgeons to apply these techniques to this difficult problem.
  
  
  METHODS
  This was a retrospective review of 21 consecutive patients who underwent laparoscopic repair of their parastomal hernias with ePTFE mesh.
  
  
  RESULTS
  Nine (43%) were ileal conduits, seven (33%) were ileostomies, and five (24%) were colostomies. Eight patients had undergone prior hernia repair. Follow-up ranges from 1 to 36 months (average 14 months). There has been one recurrence (5%). Other complications included laparoscopic re-operation for obstruction of a urinary conduit (n=1), mesh removal for infection (n=2), Clostridium Difficile colitis (n=1), pneumonia (n=2), renal failure (n=1), surgical site infection (n=1), and bowel obstruction at a site remote from the hernia repair (n=2).
  
  
  CONCLUSIONS
  The laparoscopic approach to parastomal hernias is a new technique that offers many potential advantages over conventional open repairs. Based on our initial experience, this repair seems to be associated with a low recurrence rate.
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
authors.forename: R O
authors.initials: RO
authors.lastname: Craft
authors.forename: K L
authors.initials: KL
authors.lastname: Huguet
authors.forename: E C
authors.initials: EC
authors.lastname: McLemore
authors.forename: K L
authors.initials: KL
authors.lastname: Harold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D054047:Surgical Stomas; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene