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Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Open Retromuscular Repair of Parastomal Hernias with Synthetic Mesh
Abstract:
Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test. Values of P < 0.05 were considered significant. Forty-six patients underwent retromuscular PH repair with permanent synthetic mesh. There were 26 patients with colostomies and 20 with ileostomies. All the patients were repaired using a keyhole retromuscular technique and direct passage of stoma through mesh. Transversus abdominis release was performed in 65.2 per cent of cases. Permanent synthetic polypropylene mesh was used in all cases. Surgical site occurrence occurred in 47.8 per cent of patients, SSI in 17.4 per cent, and hernia recurrence in 21.7 per cent. Resiting the stoma yielded the highest rate of SSI (40%) compared with leaving the stoma in situ (11.8%) or rematuring the stoma (0%; P = 0.011). Open keyhole retromuscular PH repair of PH with permanent synthetic mesh is safe, effective, and durable.
Insights
Open retromuscular repair using synthetic mesh is a safe and effective treatment for parastomal hernias (PHs). This technique demonstrates durability, offering a reliable solution for patients with permanent ostomies experiencing PHs.
Area of Science:
- Abdominal Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Parastomal hernias (PHs) are a common complication following ostomy creation, leading to significant patient morbidity.
- Various surgical techniques exist for PH repair, including laparoscopic and open approaches.
Purpose of the Study:
- To evaluate the safety, efficacy, and durability of open retromuscular repair for PHs using permanent synthetic mesh.
- To analyze surgical site occurrences, infections, and recurrence rates associated with this technique.
Main Methods:
- Retrospective review of a prospectively maintained database of patients undergoing PH repair.
- Open retromuscular repair using a keyhole technique with direct stoma passage through permanent synthetic polypropylene mesh.
- Analysis of surgical outcomes including surgical site occurrence, surgical site infection (SSI), and hernia recurrence.
Main Results:
- Forty-six patients underwent repair; 26 with colostomies and 20 with ileostomies.
- Surgical site occurrence was 47.8%, SSI was 17.4%, and hernia recurrence was 21.7%.
- Resiting the stoma significantly increased SSI rates (40%) compared to in situ (11.8%) or rematuring (0%; P = 0.011).
Conclusions:
- Open keyhole retromuscular PH repair with permanent synthetic mesh is a safe and effective procedure.
- The technique demonstrates durability in managing parastomal hernias.
- Avoiding stoma resiting may reduce the risk of surgical site infections.
