title: Parastomal hernia repair outcomes in relation to stoma site with diisocyanate cross-linked acellular porcine dermal collagen mesh.
abstract: OBJECTIVE
  Biologic meshes are increasingly used in parastomal hernia repair. This study evaluates the efficacy and safety of diisocyanate cross-linked acellular porcine dermal collagen mesh for parastomal hernia repair, with particular reference to the relationship of the stoma site to the rectus sheath.
  
  
  METHODS
  Hernias were repaired via a lateral approach, with onlay placement of the biologic mesh. A retrospective case note review and analysis of clinical outcomes was performed. The relationship of the stoma to the rectus sheath was determined by abdominal computed tomography (CT) and intraoperative findings.
  
  
  RESULTS
  Over a 16-month period, 27 consecutive patients, median age 72 years, underwent parastomal hernia repair utilising onlay biologic mesh to reinforce the external oblique aponeurosis. There were 20 paracolostomy and seven paraileostomy hernias. Eleven stomas passed through the rectus sheath and 16 were lateral to it. Recurrences occurred in 3 of 11 stomas within and 12 of 16 stomas lateral to the rectus sheath (P = 0.022). The median time to recurrence was 10.1 months. The median follow up of patients without recurrence was 16.6 months (range 0.2-39.3). There was one perioperative death. One patient developed a superficial post-operative abscess that was managed conservatively, but there were no complications related to the biologic mesh and no mesh required removal.
  
  
  CONCLUSIONS
  For parastomal hernias within the rectus sheath, diisocyanate cross-linked porcine dermal collagen mesh onlay repair gives good results and is safe to use. Repair of a parastomal hernia where the stoma is lateral to the rectus sheath has a significantly higher risk of recurrence and is not recommended.
authors.affiliation: Exeter Colorectal Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Smart
authors.forename: R
authors.initials: R
authors.lastname: Velineni
authors.forename: D
authors.initials: D
authors.lastname: Khan
authors.forename: I R
authors.initials: IR
authors.lastname: Daniels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D003094:Collagen / Q000009:adverse effects / Q000627:therapeutic use*; D003125:Colostomy / Q000009:adverse effects; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D017768:Skin, Artificial / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen