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Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
[«A stoma comes seldom alone» … the parastomal hernia in the 21st century - a surgical update]
1John Goligher colorectal unit, St.James University Hospital, Leeds, Vereinigtes Königreich.
Insights
Parastomal hernias (PSH) are a common complication after stoma surgery, with high recurrence rates after repair. Mesh techniques are preferred over sutures, with specific methods like open sublay and laparoscopic Sugarbaker showing better outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Parastomal hernias (PSH) are a frequent complication following ostomy creation, posing significant surgical challenges.
- High recurrence rates after surgical repair necessitate improved treatment strategies.
Purpose of the Study:
- To provide an updated surgical perspective on managing parastomal hernias.
- To evaluate the efficacy of various surgical repair techniques for PSH.
Main Methods:
- Review of current literature on open and laparoscopic surgical repair strategies for PSH.
- Comparison of recurrence rates between direct suture repair and mesh techniques.
- Analysis of different mesh placement methods (onlay, sublay, keyhole, Sugarbaker).
Main Results:
- Mesh repair techniques demonstrate lower recurrence rates compared to direct suture repair for PSH.
- Open sublay/underlay and laparoscopic Sugarbaker techniques show more favorable recurrence rates than open onlay and laparoscopic keyhole repairs.
- Prophylactic synthetic mesh use during end colostomy formation is recommended due to promising results.
Conclusions:
- Mesh-based repair is the preferred method for parastomal hernias.
- Specific mesh techniques offer superior outcomes in PSH management.
- Robotic surgery presents potential advancements for minimally invasive parastomal hernia repair.
Abstract:
«A stoma comes seldom alone» … the parastomal hernia in the 21st century - a surgical update Abstract. Parastomal hernias (PSH) remain a challenge for surgeons of the 21st century. Almost one in two patients will develop a PSH within 24 months of stoma formation and surgical repair is associated with high recurrence rates. Multiple open / laparoscopic repair strategies have been described, however, due to heterogeneity within the literature and a lack of robust evidence, guidelines are difficult to establish. Direct suture repair of PSH has demonstrated higher recurrence rates than mesh techniques, and so mesh repair is highly advocated. Looking at the different mesh techniques in terms of recurrence, open onlay and laparoscopic keyhole repair appear to have less favourable results than open sublay / underlay repair and the laparoscopic Sugarbaker technique. Use of prophylactic synthetic mesh at the time of formation of a definitive end colostomy (typically in patients undergoing abdomen-perineal resection) has demonstrated encouraging results and is therefore currently recommended. Technical innovations with robotic surgery make minimally invasive sublay repairs possible and have the potential to offer new dimensions of parastomal hernia repair.
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