Long-term follow-up of laparoscopic repair of parastomal hernia using a bilayer mesh with a slit.
BACKGROUND
Open surgery for parastomal hernia has been associated with high morbidity and recurrence rates exceeding 50%. Laparoscopic mesh repair is a promising alternative. Published series on laparoscopic mesh repair of parastomal hernia, however, are few with relative short follow-up.


METHODS
Seventy-two consecutive patients with 48 paracolostomy and 24 paraileostomy hernias were studied prospectively. Using a two-layer mesh with polypropylene on the parietal side and nonadhesive PTFE toward the viscera, a slit with a central keyhole was cut in the mesh modified after Hofstetter. Covering the fascial defect, the slit was closed laterally. Of the 70 patients discharged alive, 66 were followed for 6 months to 11 years (median=3 years). Four patients were lost for follow-up.


RESULTS
Lysis of adhesions to the anterior abdominal wall, necessary in 68 patients (94%), was frequently a cumbersome and time-consuming task. In nine patients it was the apparent cause of inadvertent full-thickness enterotomy and seromuscular lesion in three and six patients, respectively. Three procedures (4%) were converted to open surgery. Postoperative complications were observed in 16 patients (22%), nine of whom required repeat surgery (13%). Two patients (3%) died. The median hospital stay was 3 days. Late mesh-related complications were observed in five patients (7%) after 5-34 months. Three patients developed abscess that required mesh removal in two patients, including one patient with a small bowel fistula. In two patients the mesh was removed because of small-bowel obstruction and stenosis of the colon at the level of the mesh, respectively. Parastomal hernia recurred in two patients 1 month and 52 months after surgery (recurrence rate=3%, 95% confidence interval=1-10).


CONCLUSIONS
Laparoscopic repair of parastomal hernia using bilayer mesh with a slit is associated with a risk of substantial postoperative morbidity, including late mesh-related complications, but a recurrence rate of less than 10%.
Wara
Paul
P
Department of Surgery, Aarhus University Hospital, Tage-Hansensgade 2, 8000, Aarhus C, Denmark. p.wara@dadlnet.dk
Andersen
Lars Maagaard
LM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003125:Colostomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome