Revisional laparoscopic parastomal hernia repair.
BACKGROUND
We herein report a laparoscopically performed re-do operation on a patient who had previously undergone a laparoscopic parastomal hernia repair.


METHODS
We describe the case of a 71-year-old patient who presented within 3 months of her primary laparoscopic parastomal hernia repair with recurrence. On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac. This had allowed loops of small bowel to herniate into the sac. The initial part of the procedure involved the lysis of adhesions. A piece of Gore-Tex DualMesh with a central keyhole and a radial slit was cut so that it could provide at least 3 cm to 5 cm of overlap of the fascial defect. The tails of the mesh were wrapped around the bowel, and the mesh was secured to the margins of the hernia with circumferential metal tacking and 4 transfascial sutures. The patient remains in satisfactory condition and no recurrence or any surgery-related problem has been observed during 8 months of follow-up.


CONCLUSIONS
Revisional laparoscopic repair of parastomal hernias seems feasible and has been shown to be safe and effective in this case. The success of this approach depends on longer follow-up reports and standardization of the technical elements.
Zacharakis
Emmanouil
E
Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London United Kingdom. manoszacharakis@hotmail.com
Shalhoub
Joseph
J
Selvapatt
Nowlan
N
Darzi
Ara
A
Ziprin
Paul
P
D000368:Aged; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*