Parastomal hernia-repair using mesh and an open technique.
BACKGROUND
Parastomal hernia occurs in 35%-50% of patients who have had a stoma formed, whether for the digestive tract or the urinary tract. There are many repair techniques including primary repair and repair using different types of mesh prosthesis, and the surgical approach may be open or laparoscopic. However, all techniques suffer the disadvantage of a high index of hernia recurrence.


METHODS
This study included 125 patients from the stoma clinic at our hospital. Hernia repair was performed on 25 of these patients who had a terminal colostomy because of either cancer or inflammatory disease. Preoperative colon preparation involved a cathartic, an evacuating enema, and antibiotic therapy in the preoperative period. The repair was conducted via an anterior approach, dissecting the skin around the stoma in the way a plastic surgeon handles an umbilical scar during abdominoplasty, in order to enter the hernia site. The hernial sac was left intact to form a bed on which to lay a lightweight polypropylene mesh, and this was then fixed to the deep face of the aponeurosis all around the stoma, with sutures placed in a U-shape with 1/0 or 2/0 non-absorbent material. The mesh was also fixed to the external surface of the colon with simple sutures of 3/0 polyglycocolic acid. A closed supra-aponeurotic drain was left in situ, and the skin was closed with 3/0 nylon.


RESULTS
Of the corpus, 50 patients presented with parastomal hernia (40%), and 25 of them underwent surgery. These patients were followed for a period of 12 months, on average (range: 8-24 months). After operation, 2 patients (8%) experienced hernia recurrence and underwent further surgery to reinforce the abdominal wall with a new insertion of mesh prosthesis; 2 patients (8%) suffered surgical wound infection; and 2 patients (8%) developed a seroma. There was no rejection of the mesh, erosion of the colon, or fistula formation.


CONCLUSIONS
Inserting a mesh prosthesis by this technique is a safe effective treatment for parastomal hernia, adding another option to the available repair solutions. Prospective and comparative studies are required to reinforce this study, and they should ideally include a greater number of patients in the study corpus.
Guzmán-Valdivia
Gilberto
G
Department of General Surgery, Gabriel Mancera Regional General Hospital No. 1 IMSS (Mexican Institute of Social Security), Mexico City 03100, Mexico. guzvaldi@yahoo.com
Guerrero
Teresa Soto
TS
Laurrabaquio
Hilda Varela
HV
D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome