A Novel Technique for Parastomal Hernia Repair Combining a Laparoscopic and Ostomy-Opening Approach

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 28; no. 2; p. 209
• Main Authors: Köhler, Gernot, Fischer, Ines, Wundsam, Helwig
• Format: Journal Article
• Language: English
• Published: United States 01-02-2018
• Subjects: Aged; Female; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Humans; Incisional Hernia - surgery; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Middle Aged; Ostomy - adverse effects; Ostomy - methods; Pilot Projects; Prospective Studies; Surgical Mesh - adverse effects; Surgical Stomas - adverse effects; parastomal hernia; keyhole; 3D funnel mesh; Sugarbaker
• ISSN: 1557-9034
• DOI: 10.1089/lap.2017.0313

The aim of this study was to evaluate a new method of parastomal hernia (PSH) repair by using a hybrid approach with a cylindrical-shaped mesh of 4 cm funnel length.
In a pilot prospective case series, 12 patients underwent surgical repair of PSHs with a combined laparoscopic and ostomy-opening approach. After laparoscopic adhesiolysis, the ostomy opening was excised from outside and the bowel was closed. The hernia sac was excised after reduction of its content. Then, the bowel was guided through the funnel of the mesh and the implant was manually transferred into the peritoneal cavity through the hernia defect. Next, the fascial margins were narrowed with sutures. Laparoscopy was continued, and the mesh was placed and fixed with absorbable tacks in the proper position. Finally, the diverted bowel was shortened outside of the abdomen and the stoma was matured in its original location.
We documented no mesh-associated complications. Only one superficial peristomal wound defect occurred. No unplanned conversions were needed, and median duration of the operations was 72 minutes. There was no recurrence during the short-term follow-up of median 4 months (ranged from 3 to 8 months).
The technique described gives several advantages, such as a minimally invasive hybrid approach creating a real three-dimensional mesh-covered barrier between the trephine and stomal limb and optional shortening of a concomitant prolapse. When needed due to a concomitant incisional hernia, a second flat mesh can be laparoscopically placed in an intraperitoneal position.