Parastomal hernia repair using the lateral approach

Abstract

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.

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

“…Regardless of approach, the literature shows recurrence to be more common in obese patients and in patients with large hernias. In such cases, the authors recommend relocating the stoma to the contralateral side, as described by Kaufman [1,3,9] . Unfortunately, stoma translocation has been associated with a complication rate of up to 88% [7] .…”

“…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] .…”

“…Surgical correction without the use of a mesh, as generally practiced until the early 1990s, has been associated with recurrence rates of up to 63% [7] , but with the adoption of meshes made of polypropylene and similar materials, recurrence rates have fallen to as little as 7% [3,5,8] . Regardless of approach, the literature shows recurrence to be more common in obese patients and in patients with large hernias.…”

“…Contributing factors are similar to those observed for hernias of the abdominal wall: chronic cough, obesity, malnutrition, diabetes mellitus and use of corticosteroids [2,4] . Although most patients are asymptomatic, some may present complications requiring surgical repair, such as pain, distress, abdominal wall distortion and inadequate attachment of the ileostomy bag with the risk of urine leaks and intestinal obstruction or loop stricture [2][3][4] .…”

“…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] . Other authors [1,9,10] prefer to relocate the stoma, i.e.…”