Changes in the Surgical Management of Parastomal Hernias Over 15 Years: Results of 135 Cases.
BACKGROUND
Over the years, various open and laparoscopic approaches toward the repair of parastomal hernias (PSH) have been described. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures.


METHODS
From January 1999 to January 2014, we assessed all cases of PSH repair performed at the three participating surgical departments in a retrospective analysis. The results were evaluated with regard to different surgical techniques focusing on complications and recurrences.


RESULTS
One hundred and thirty-five individuals could be included in the analysis. They were operated on with eight different surgical techniques. Laparoscopic procedures were carried out in 46.7 % (63/135) of the cases. Median follow-up was 54 months (12-146 months). We found 44 cases of recurrence (32.6 %) and 24 (17.8 %) of the patients experienced perioperative complications and 12 of them needed to return to theater. Fourteen of the 135 patients (10.4 %) were operated as emergency cases which were associated with a mortality of 28.6 % (4/14). In case of elective PSH repair, no mortality occured.


CONCLUSIONS
The results achieved by direct suture or the use of incised flat meshes for the repair of PSH were poor with these procedures having unacceptably high recurrence rates. With regard to the latter ostomy revision through three-dimensional funnel-shaped meshes and the laparoscopic sandwich technique showed the best results. Emergency procedures were linked to a dramatic increase in morbidity and mortality (p < 0.001).
Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria. gernot.koehler@bhs.at.|Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria. gernot.koehler@bhs.at.|Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria. gernot.koehler@bhs.at.|Department of Surgery, Paracelsus Medical University, Salzburg, Austria. gernot.koehler@bhs.at.
Gernot
G
Köhler
Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
Franz
F
Mayer
Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.|Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria.|Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria.
Helwig
H
Wundsam
Department of Surgery, Hospital Bruck an der Mur, Bruck an der Mur, Austria.
Rudolf
R
Schrittwieser
Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.|Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria.|Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria.
Klaus
K
Emmanuel
Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
Michael
M
Lechner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*