Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients

Abstract

Background: Parastomal herniation is a common complication, and its operative treatment is notoriously difficult. Recently, the authors have described a laparoscopic technique for closure and reinforcement of the hernia with a hand-made ''funnel-shaped'' Gore-Tex Dual Mesh. Potentially this technique combines the advantages of a mesh repair with those of minimal invasive surgery. Methods: In 2002, a multicenter trial of this new technique was started in The Netherlands. To date, 55 consecutive patients (27 men; median age, 63 years) with a symptomatic primary (n = 45) or recurrent (n = 10) parastomal hernia have undergone elective surgery using this technique. The demographic, perioperative, and early follow-up data prospectively collected for these patients are presented in this report. Results: Of the 55 procedures, 47 (85.5%) could be completed laparoscopically (median operation time, 120 min). Conversion to laparotomy was indicated because of dense adhesions prohibiting safe dissection (n = 4) or bowel injury (n = 4). No in-hospital mortality occurred. Postoperative recovery was uneventful for 47 patients (85%), who had a median hospital stay of 4 days. Surgical and nonsurgical complications occurred, respectively, for four patients each (7.2%). Full-thickness enterotomy appeared to be the most troublesome complication. After 6 weeks, when all the patients were reexamined, one recurrence was noted. Conclusion: Maximal efforts should be undertaken to prevent perioperative full-thickness enterotomy. Because this was achieved for the vast majority of patients, it is concluded that laparoscopic parastomal hernia repair is feasible and safe. Although a longer follow-up period is needed for definitive conclusions to be drawn regarding the recurrence rate, early follow-up evaluation shows very promising results.

Manejo das hérnias paraestomais

“…The colon is involved by the defect in the prosthesis and it is fixed to the aponeurosis 15 . In both techniques, the mesh should be set to overcome the defect circumferentially in at least 5 cm.…”

Laparoskopische Reparation der parastomalen Hernie

“…Im Jahr 2007 wurde die erste größere Se rie zur Schlüssellochtechnik publiziert [7]. Die Rezidivrate war erstaunlich gering, die Nachbeobachtungszeit betrug aller dings nur 6 Wochen.…”

Reply to: laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results

“…Parastomal hernia surgery has been my principal point of interest for many years. In their discussion, the authors refer incorrectly to two of my publications [2,3].…”

“…No modification of the technique was performed, and no open technique was described. Rather, as the title of the publication indicates, this is a publication of the short-term results of a prospective clinical study on 55 consecutive patients operated solely by laparoscopy [2]. It was concluded that the laparoscopic keyhole technique is a safe and feasible technique to repair parastomal hernias.…”