Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate.
BACKGROUND
Parastomal herniation is a common complication of stoma formation, and its operative treatment is notoriously difficult. Recently we have reported the promising short-term results of a keyhole technique in which a Gore-Tex Dual Mesh with a central keyhole is laparoscopically fashioned around the bowel to close the hernia. In the long-term, recurrence is one of the major issues in hernia repair, therefore, this aspect was prospectively investigated.


METHODS
Since 2002, a total of 55 consecutive patients (27 men; median age, 63 years) with a symptomatic primary (n = 45) or recurrent parastomal hernia (n = 10) were electively operated using this technique. Patients were invited to the outpatient clinic on a regular basis and were examined for the occurrence of a recurrent hernia. At the last visit, all patients were asked to complete a short questionnaire.


RESULTS
Median follow-up (98%) was 36 (range, 12-72) months. During follow-up a recurrent parastomal hernia was diagnosed in 20 patients (37%). Three recurrences were asymptomatic and were treated conservatively. The other 17 patients (85%) developed mild-to-severe symptoms necessitating redo-surgery in 9 (45%) patients. Surprisingly, satisfaction with the procedure was high among patients (89%), even in the presence of a recurrence. Patients who reported unsatisfactory results belonged mainly to the group in whom the initial laparoscopic approach had to be converted to an open procedure.


CONCLUSIONS
Based on the results from the present study, which represents one of the largest patient series with the longest follow up available to date, it is concluded that laparoscopic parastomal hernia repair using a keyhole technique has an intolerably high recurrence rate with the currently available meshes. A new mesh with a less pliable central part and without the tendency to shrink is awaited.
Hansson
B M E
BM
Department of Surgery, Canisius Wilhelmina Hospital, Postbus 9015, Nijmegen, The Netherlands. b.hansson@cwz.nl
Bleichrodt
R P
RP
de Hingh
I H
IH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011138:Polytetrafluoroethylene; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D013526:Surgical Mesh / Q000009:adverse effects*; D054047:Surgical Stomas / Q000009:adverse effects*; D055815:Young Adult
D011138:Polytetrafluoroethylene