Laparoskopische Reparation der parastomalen Hernie

Abstract

Parastomal hernias are a common complication after stoma formation. An exact evaluation of the history of the patients reveals clinically impairing symptoms in the majority of patients. The surgical treatment should generally be based on the augmentation or even replacement of the abdominal wall by non-resorbable meshes. The laparoscopic repair can be performed using the intraperitoneal placement of a mesh according to Sugarbaker with a wide lateralization of the stoma loop, the keyhole-technique, which means an incised mesh placed around the stoma loop, or the combination of both techniques (sandwich-technique). By far the best results can be achieved with the sandwich-technique. The recurrence rate in our series is less than 3% with an acceptable complication rate. The literature demonstrates high recurrence rates after keyhole-repair and the Sugarbaker-technique was also shown to be ineffective by our own data. In summary the laparoscopic sandwich-technique is a technically challenging but very successful method for long-lasting repair of parastomal hernias leading to an astonishingly low recurrence rate.

Polish guidelines for treatment of patients with parastomal hernia

“…The number of cases of intestinal damage reported in papers ranges from approx. 2% (94,95) to even 10-20%. In Hansson's study intestinal damage rate was 10.9%, in case of primary hernias and even 20% in case of recurrent hernias (96).…”

“…It seems, however, that the mesh should be shaped with a margin of at least 5 cm around the stoma -as in classical abdominal hernia surgeries. In one study, specially shaped implant attached laparoscopically inside the peritoneum demonstrated a 100% efficiency, which might prove its usefulness in hernia prevention (95).…”

“…Similarly as in abdominal hernia treatment, development of seromas is observed. The number of seromas with laparoscopic methods ranges from 8% (94,95) to even 35% (67). Large volume, symptomatic seromas require aspiration.…”

Laparoscopic restoration of intestinal continuity following Hartmann procedure

“…Ziel der Untersuchung war die Klärung der Frage, ob die laparoskopische Kontinuitätswiederherstellung bei operativen Schwierigkeiten, wie veränderten anatomischen Gegebenheiten, bei ausgepräg-ten interenterischen Adhäsionen, fehlenden Grenzschichten und kompromittierten Durchblutungsverhältnissen bei vorhergehender Resektion der A. rectalis superior oder A. mesenterica inferior [9] sicher durchführbar ist und zur Senkung der hohen Morbidität und potenziellen Letalität dieses Eingriffs beitragen kann [6,10,11]. (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Es gab keine peri- oder postoperative Letalität.…”

“…Postope ratively, three (15.7%) minor complications (2× pneumonia, 1× protracted intestinal atonia) and four (21%) major complications requiring surgical intervention (2× wound infection, 1× adhesion ileus and 1× trocar site hernia) were observed. The median follow-up was eight (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months. There were no peri- or postoperative mortalities.…”