Single-port parastomal hernia repair by using 3-D textile implants.
BACKGROUND
Parastomal hernias (PSHs) are a frequent complication and remain a surgical challenge. We present a new option for single-port PSH repair with equilateral stoma relocation using preshaped, prosthetic 3-dimensional implants and flat mesh insertion in intraperitoneal onlay placement for additional augmentation of the abdominal wall.


METHODS
We describe our novel technique in detail and performed an analysis of prospectively collected data from patients who underwent single-port PSH repair, focusing on feasibility, conversions, and complications.


RESULTS
From September 2013 to January 2014, 9 patients with symptomatic PSHs were included. Two conversions to reduced-port laparoscopy using a second 3-mm trocar were required because of difficult adhesiolysis, dissection, and reduction of the hernia sac content. No major intra- or postoperative complications or reoperations were encountered. One patient incurred a peristomal wound healing defect that could be treated conservatively.


CONCLUSIONS
We found that single-port PSH repair using preshaped, elastic 3-dimensional devices and additional flat mesh repair of the abdominal wall is feasible, safe, and beneficial, relating to optimal coverage of unstable stoma edges with wide overlap to all sides and simultaneous augmentation of the midline in the IPOM technique. The stoma relocation enables prolapse treatment and prevention. The features of a modular and rotatable multichannel port system offer benefits in clear dissection ongoing from a single port. Long-term follow-up data on an adequate number of patients are awaited to examine efficacy.
Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria.
Gernot
G
Köhler
Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria.
Klaus
K
Emmanuel
Department of General Surgery, LKH, Bruck an der Mur, Austria.
Rudolf
R
Schrittwieser
D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D066330:Printing, Three-Dimensional; D011474:Prosthesis Design; D013526:Surgical Mesh
Laparoscopic repair; Parastomal hernia; Prevention; Single incision; Single port; Single site