Laparoscopic Management of Parastomal Hernia in Transileal Urinary Diversion

Dunet, Frédérick; Pfister, Christian; Rey, Denis; PASCAL, THOMAS; Khalil, Haitham; Peillon, Christophe

doi:10.1016/s0022-5347(05)65422-5

Cited by 13 publications

(4 citation statements)

References 10 publications

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“…Laparoscopic techniques have also been proposed but have not been tested sufficiently. So far open parastomal repair is considered the gold standard treatment for this condition [3,6] .…”

Section: Discussionmentioning

confidence: 99%

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Extraperitoneal Surgical Repair of Parastomal Hernia of Bricker’s Urinary Diversion with Polypropylene Mesh: Stoma Reimplantation through the Mesh

Lima¹,

Regadas²,

Tavares³

et al. 2010

Urol Int

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Introduction: 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 situthrough the mesh. Patient and 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.

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“…Laparoscopic techniques have also been proposed but have not been tested sufficiently. So far open parastomal repair is considered the gold standard treatment for this condition [3,6] .…”

Section: Discussionmentioning

confidence: 99%

“…Some authors favor the use of a mesh, and transperitoneal access may be achieved by laparotomy [3,5] or videolaparoscopy [2,3,6] . In some techniques, the stoma is left in the original position [3,7,8] .…”

Section: Introductionmentioning

confidence: 99%

Extraperitoneal Surgical Repair of Parastomal Hernia of Bricker’s Urinary Diversion with Polypropylene Mesh: Stoma Reimplantation through the Mesh

Lima¹,

Regadas²,

Tavares³

et al. 2010

Urol Int

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“…19,23,24 In fear of infectious complications, some authors advocate the placement of a prosthesis in a lower fascial plane through the peritoneum through the old midline incision 22,[27][28][29][30][31] or, more recently, laparoscopically. [32][33][34][35][36][37][38][39] These approaches are claimed to be aseptic, and the operation can be performed in an otherwise potentially contaminated field. We could not agree more with the advantages of working in an aseptic field; however, if the surgeon does not dissect the hernial sac and does not correct the fascial flaw, we believe the risk of recurrence with extrusion of the prosthesis is higher.…”

Section: Discussionmentioning

confidence: 99%

Role of Biological Mesh in Surgical Treatment of Paracolostomy Hernias

Araújo¹,

Habr‐Gama²,

Teixeira³

et al. 2005

Clinics

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BACKGROUND: Paracolostomy hernia is a frequent complication of intestinal stoma. Its correction can be made through relocation of the colostomy or by keeping it in place and performing abdominal wall reinforcement through direct suturing with or without a prosthesis. METHOD: Results of surgical treatment of paracolostomy hernias were analyzed in 22 patients who underwent surgery in our hospital during the past 15 years, with or without biological mesh (bovine pericardium). All patients had terminal colostomies after abdominoperineal excision of the rectum. RESULTS: In 15 (68.2%) patients, hernia correction was made by maintaining the colostomy in place, in 2 of them (9.1%) without reinforcement, and in the other 13 (59.1%) through reinforcement of the aponeurosis with biological mesh. In the 7 (31.8%) other patients, hernia correction was accomplished by relocation of the colostomy. The mean follow-up period was 50.2 months. Recurrence was observed in 3 (13.6%) patients after a median of 16 months post-correction. CONCLUSION: Paracolostomy hernia remains a surgical challenge due to its high recurrence rate. Primary repair using a prosthesis of biological material may be preferable since muscle-aponeurotic weakness is frequently observed.

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“…Until newer techniques such as laparoscopic repair [10] are established and confirmed as credible, open parastomal hernia repair remains the 'reference' standard. We recommend the lateral approach be included in the available options for managing the parastomal hernia.…”

Section: Discussionmentioning

confidence: 99%

Parastomal hernia repair using the lateral approach

Fawcett

2004

BJU International

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OBJECTIVETo review the results of repairing a parastomal hernia after ileal conduit formation, using the lateral approach.PATIENTS AND METHODSWe retrospectively assessed 18 patients (9%) who developed a parastomal hernia, from 211 who had an ileal conduit created between 1982 and 2001; 15 had a surgical repair using a lateral incision.RESULTSAll 15 patients resumed a normal diet 1 day after surgery; the median (range) hospital stay was 4 (2–14) days. In two patients with a large hernia and difficult repair the stomas became ischaemic and required refashioning. Only one of these two patients required complete conduit replacement. The median (range) follow‐up was 15 (1–72) months. A recurrence of the hernia was recorded in one grossly overweight patient.CONCLUSIONThe lateral approach obviates the need for laparotomy and stomal relocation, and enhances a quick return of bowel function and early recovery. However, extra care is needed in managing the very large and difficult hernia, to avoid compromising the ileal conduit. The success and complication rates of the current series are within acceptable limits and this technique can be included in the options for managing parastomal hernia.

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Laparoscopic Management of Parastomal Hernia in Transileal Urinary Diversion

Cited by 13 publications

References 10 publications

Extraperitoneal Surgical Repair of Parastomal Hernia of Bricker’s Urinary Diversion with Polypropylene Mesh: Stoma Reimplantation through the Mesh

Extraperitoneal Surgical Repair of Parastomal Hernia of Bricker’s Urinary Diversion with Polypropylene Mesh: Stoma Reimplantation through the Mesh

Role of Biological Mesh in Surgical Treatment of Paracolostomy Hernias

Parastomal hernia repair using the lateral approach

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