Extraperitoneal surgical repair of parastomal hernia of Bricker's urinary diversion with polypropylene mesh: stoma reimplantation through the mesh.
BACKGROUND
Parastomal hernias affect 4.5-9% of patients submitted to ileostomy. Correcting this hernia represents a challenge. There are two basic approaches to the surgical correction of parastomal hernias: stoma relocation and repair in situ. We describe an alternative modified technique for extraperitoneal correction of large parastomal hernias using a polypropylene mesh and reimplantation of the urostomy in situ through the mesh.


METHODS
An 80-year-old patient submitted to Bricker urinary diversion developed a large parastomal hernia affecting almost the entire circumference causing local pain and difficulties in appliance attachment. An ellipsoid skin incision around the urostomy was done and skin flaps were dissected up to the aponeurotic borders keeping the hernia sac intact. A polypropylene mesh was sutured onto the aponeurotic borders, the urostomy was led back through a central opening in the mesh, and the skin segment was stitched onto the mesh.


RESULTS
The patient was discharged on the third postoperative (PO) day. On day 14 PO he presented a small area of dehiscence treated with resuture. By the 30th month, no changes had occurred in the stoma or in the upper urinary tract and the patient was asymptomatic with no signs of tumor or hernia recurrence.


CONCLUSIONS
Simple to perform and associated with low morbidity, the procedure represents an alternative for the treatment of parastomal hernias that would otherwise require stomal relocation.
Department of Urology, Cancer Hospital of Ceará, Fortaleza, Brazil. marcosvalima @ hotmail.com
Marcos Venício Alves
MV
Lima
Rommel Prata
RP
Regadas
José Marconi
JM
Tavares
Lúcio Flávio
LF
Gonzaga Silva
D000369:Aged, 80 and over; D006555:Hernia, Ventral / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D011126:Polypropylenes; D012086:Reoperation; D012092:Replantation / Q000295:instrumentation*; D013524:Surgical Flaps; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*; D013536:Suture Techniques; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000009:adverse effects*
D011126:Polypropylenes