A novel approach for the simultaneous repair of large midline incisional and parastomal hernias with biological mesh and retrorectus reconstruction.
BACKGROUND
Patients with concomitant large midline incisional and parastomal hernias present many unique challenges to the reconstructive surgeon.


METHODS
We describe a novel approach of simultaneously repairing the midline incisional and parastomal defect, while prophylactically reinforcing the relocated stoma site with a retrorectus biological graft.


RESULTS
During the study period, 9 men and 3 women with a mean age of 65 years, body mass index (BMI) 34 kg/m2, and American Society of Anesthesiologists score (ASA) 3.1 underwent repair. Hernia defects averaged 338 cm2. Seven patients had a myofascial advancement flap. Mean operative time was 277 minutes. Postoperative complications occurred in 4 patients (33%) and included superficial surgical site infection, transient renal failure, and deep venous thrombosis; in addition, 1 patient died suddenly on postoperative day 3. After a mean follow-up of 14 months, 2 patients have asymptomatic hernia recurrence.


CONCLUSIONS
The use of various advanced abdominal wall reconstructive techniques may offer an acceptable approach to repairing these challenging defects.
Department of General and Gastrointestinal Surgery, University Hospitals of Cleveland, Case Medical Center, Cleveland, OH, USA. michael.rosen@uhhopsitals.org
Michael J
MJ
Rosen
Harry L
HL
Reynolds
Bradley
B
Champagne
Conor P
CP
Delaney
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000009:adverse effects; D019651:Plastic Surgery Procedures; D017568:Rectus Abdominis / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh
D001672:Biocompatible Materials