, Volume 18, Issue 5, pp 653–661 | Cite as

Parastomal hernia repair with a 3-D mesh device and additional flat mesh repair of the abdominal wall

  • G. Köhler
  • O. O. Koch
  • S. A. Antoniou
  • M. Lechner
  • F. Mayer
  • U. Klinge
  • K. Emmanuel
Original Article



Parastomal hernias (PSHs) have been a major clinical problem. The aim of this study was to evaluate a new method of PSH repair in combination with an additional flat mesh reinforcement of the abdominal wall.


In a pilot case series, seven patients suffering from complex PSHs (≥5 cm diameter and/or recurrence) underwent surgery and were treated by intraperitoneal onlay technique (IPOM) with a synthetic 3-D funnel-shaped mesh implant. The demographics, perioperative, and follow-up data are presented in this report.


The surgical strategy varied between purely laparoscopic (n = 1), laparoscopically assisted (hybrid n = 3), or open techniques (n = 3) using original or suture-reconstructed mesh devices. The funnel mesh implantations in IPOM technique were combined with attached flat meshes in the appropriate position of the abdominal wall. No procedure-related complications occurred. The mean length of hospital stay was 12 days and the mean operating time was 171 min. No recurrence of PSH or incisional hernias was observed during a mean follow-up period of 12.3 months (range from 7 to 22).


The use of a 3-D mesh implant has so far shown to be a promising option in the treatment of primary and recurrent PSHs. Its use proved to be reasonable in both laparoscopic and open IPOM technique. PSHs were preferably repaired using the original, unmodified implant, but when we also found it safe to incise, place and then suture the mesh around the pre-existing ostomy.


Parastomal hernia Abdominal wall hernia Intraperitoneal onlay mesh 


Conflict of interest

GK declares no conflict of interest. OK declares no conflict of interest. SA declares no conflict of interest. ML declares no conflict of interest. FM declares no conflict of interest. UK declares conflict of interest not directly to the submitted work (consulting and/or speaking fees and expert testimony in the field of mesh surgery from FEG Aachen, Life Cell Corp.,CR Bard Inc., Ethicon). KE declares no conflict of interest.


  1. 1.
    Cingi A, Cakir T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49(10):1559–1563PubMedCrossRefGoogle Scholar
  2. 2.
    Klinge U, Binnebösel M, Rosch R, Mertens P (2006) Hernia recurrence as a problem of biology and collagen. J Minim Access Surg 2(3):151–154PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Rieger N, Moore J, Hewett P, Lee S, Stephens J (2004) Parastomal hernia repair. Colorectal Dis 6(3):203–205PubMedCrossRefGoogle Scholar
  4. 4.
    Jänes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91(3):280–282PubMedCrossRefGoogle Scholar
  5. 5.
    Berger D (2008) Prevention of parastomal hernias by prophylactic use of a specially designed intraperitoneal onlay mesh (Dynamesh IPST). Hernia 12(3):243–246PubMedCrossRefGoogle Scholar
  6. 6.
    Berger D (2010) Laparoscopic repair of parastomal hernia. Chirurg 81(11):988–992PubMedCrossRefGoogle Scholar
  7. 7.
    Hansson BM, Bleichrodt RP, de Hingh IH (2009) Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate. Surg Endosc 23(7):1456–1459PubMedCrossRefGoogle Scholar
  8. 8.
    Berger D, Bientzle M (2007) Laparoscopic repair of parastomal hernias: a single surgeon’s experience in 66 patients. Dis Colon Rectum 50:1668–1673PubMedCrossRefGoogle Scholar
  9. 9.
    Sugarbaker PH (1985) Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann Surg 201:344–346PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S (2009) The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 11(2):173–177PubMedCrossRefGoogle Scholar
  11. 11.
    Smietański M, Szczepkowski M, Alexandre JA, Berger D, Bury K, Conze J, Hansson B, Janes A, Miserez M, Mandala V, Montgomery A, Morales Conde S, Muysoms F (2014) European Hernia Society classification of parastomal hernias. Hernia 18:1–6PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Rives J, Lardennois B, Pire JC, Hibon J (1973) Large incisional hernias. The importance of flail abdomen and of subsequent respiratory disorders. Chirurgie 99:547–563PubMedGoogle Scholar
  13. 13.
    Chevrel JP (1979) The treatment of large midline incisional hernias by “overcoat” plasty and prosthesis. Nouv Presse Med 8(9):695–696PubMedGoogle Scholar
  14. 14.
    Stechemesser B, Jacob DA, Schug-Paß C, Köckerling F (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16(3):269–276PubMedCrossRefGoogle Scholar
  15. 15.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Schmiegel W, Reinacher-Schick A, Arnold D, Graeven U, Heinemann V, Porschen R, Riemann J, Rödel C, Sauer R, Wieser M, Schmitt W, Schmoll HJ, Seufferlein T, Kopp I, Pox C (2008) Update S3-guideline “colorectal cancer” 2008. Z Gastroenterol 46(8):799–840PubMedCrossRefGoogle Scholar
  17. 17.
    Rosch R, Junge K, Böhm G, Conze J, Schumpelick V (2008) Surgical treatment and prophylaxis of parastomal hernias]. Zentralbl Chir 133(5):464–467PubMedCrossRefGoogle Scholar
  18. 18.
    Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90(7):784–793PubMedCrossRefGoogle Scholar
  19. 19.
    Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255(4):685–695PubMedCrossRefGoogle Scholar
  20. 20.
    LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetraflouroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41PubMedGoogle Scholar
  21. 21.
    Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716PubMedCrossRefGoogle Scholar
  22. 22.
    Ramirez OM, Ruas E, Dellon AL (1990) Component separation method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526PubMedCrossRefGoogle Scholar
  23. 23.
    Klinge U, Klosterhalfen B, Ottinger AP, Junge K, Schumpelick V (2002) PVDF as a new polymer for the construction of surgical meshes. Biomaterials 23(16):3487–3493PubMedCrossRefGoogle Scholar
  24. 24.
    Jänes A, Cengiz Y, Israelsson LA (2010) Experiences with a prophylactic mesh in 93 consecutive ostomies. World J Surg 34(7):1637–1640PubMedCrossRefGoogle Scholar
  25. 25.
    Tam KW, Wei PL, Kuo LJ, Wu CH (2010) Systematic review of the use of a mesh to prevent parastomal hernia. World J Surg 34(11):2723–2729PubMedCrossRefGoogle Scholar
  26. 26.
    Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, Darnell A, Mora-Lopez L, Alcantara-Moral M, Ayguavives-Garnica I, Navarro-Soto S (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249(4):583–587PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • G. Köhler
    • 1
    • 2
    • 3
  • O. O. Koch
    • 1
    • 2
    • 3
  • S. A. Antoniou
    • 4
  • M. Lechner
    • 5
  • F. Mayer
    • 5
  • U. Klinge
    • 6
  • K. Emmanuel
    • 1
    • 2
    • 3
  1. 1.Department of General and Visceral SurgerySisters of Charity HospitalLinzAustria
  2. 2.Academic Teaching Hospital of the Universities of GrazGrazAustria
  3. 3.Academic Teaching Hospital of the Universities of InnsbruckInnsbruckAustria
  4. 4.Center for Minimally Invasive SurgeryHospital NeuwerkMoenchengladbachGermany
  5. 5.Department of SurgeryParacelsus Medical UniversitySalzburgAustria
  6. 6.Department of General, Visceral and Transplantation SurgeryRWTH Aachen UniversityAachenGermany

Personalised recommendations