Laparoscopic parastomal hernia repair.
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.
Craft
R O
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Department of Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
Huguet
K L
KL
McLemore
E C
EC
Harold
K L
KL
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
D011138:Polytetrafluoroethylene