The use of human acellular dermal matrix for parastomal hernia repair in patients with inflammatory bowel disease: a novel technique to repair fascial defects.
OBJECTIVE
Parastomal hernias occur frequently in patients with inflammatory bowel disease who require a stoma and are associated with high recurrence rates. The tissue weakness at the site of hernia can be overcome by creating neofascia using two separate layers of human acellular dermal matrix.


METHODS
Thirteen consecutive patients with inflammatory bowel disease with symptomatic parastomal hernia underwent open parastomal hernia repair at an academic tertiary referral center whereby the posterior and anterior rectus fascia at the stoma site was reconstructed with human acellular dermal matrix. Patients were followed prospectively for 290 +/- 119 days (mean +/- standard deviation), and data were reviewed for rate of postoperative complications, hernia recurrence, and patient satisfaction.


RESULTS
Mean operative time was 233 +/- 80 (range, 129-355) minutes. No intraoperative complications occurred. Average hospital stay was 8.1 +/- 2.4 (range, 6-14) days. Postoperative complications included seroma formation, incisional separation (2 patients each, 15.4 percent), and superficial wound infection (1 patient, 7.7 percent). There were two cases of asymptomatic hernia recurrence as determined by computerized tomography. These patients did not require any intervention. Overall patient satisfaction with the procedure was high.


CONCLUSIONS
In patients with parastomal hernia, reconstruction of the stoma site and abdominal wall with human acellular dermal matrix seems to be safe and results in high patient satisfaction.
Taner
Timucin
T
Division of Gastrointestinal and General Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Cima
Robert R
RR
Larson
David W
DW
Dozois
Eric J
EJ
Pemberton
John H
JH
Wolff
Bruce G
BG
D034861:Abdominal Wall / Q000601:surgery; D001672:Biocompatible Materials; D003094:Collagen / Q000627:therapeutic use*; D013505:Digestive System Surgical Procedures / Q000379:methods; D000071938:Fasciotomy; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015212:Inflammatory Bowel Diseases; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D017768:Skin, Artificial; D054047:Surgical Stomas / Q000009:adverse effects*
C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen