The modified laparoscopic keyhole parastomal hernia repair with in situ re-ostomy has low recurrence rate
- 183 Downloads
This study aimed to present a modified laparoscopic keyhole parastomal hernia repair technique with in situ re-ostomy and show its safety and feasibility at a mid-term follow-up.
The technique begins with adhesiolysis during laparoscopy. An annular incision is made between the skin and stomal mucosa. Then, after all adhesions of the stomal bowel and its mesentery are separated from the hernial sac, the stomal bowel is delivered through the keyhole mesh. The mesh is then stitched to the stomal bowel and placed intraperitoneally. The hernial ring is narrowed, and the mesh is further stitched to the hernial ring and stomal tube. After the mesh is fixed, the redundant stomal bowel is shortened, and a new in situ stoma is matured in the conventional way.
Altogether, 65 consecutive patients underwent successful hernia repair via a modified laparoscopic keyhole with in situ re-ostomy. Two of the patients had recurrent parastomal hernias. No mortalities occurred during the perioperative period. Morbidities included two cases of seroma and three of ileus, all of which were cured with conservative treatment. In addition, one case of intestinal perforation was rescued by intestinal resection and enteroenterostomy. Median follow-up was 29 months (range 3–60 months). No complications of mesh-related infection or patch erosion were noted during the follow-up.
Modified laparoscopic keyhole parastomal hernia repair with in situ re-ostomy is a safe procedure with a low recurrence rate at the mid-term follow-up.
KeywordsLaparoscopy Parastomal hernia Re-ostomy Recurrent Abdominal
This work was supported by the National Natural Science Foundation of China (no. 81600059/81370496) and Natural Science Foundation of Shandong Province Grants (ZR2014HQ004). We thank Nancy Schatken BS, MT(ASCP), from Liwen Bianji, Edanz Group China (http://www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.
Conception: Guangyong Zhang, Haifeng Zhang; Acquisition of data: Zhibo Yan, Haifeng Zhang, Hanxiang Zhan, Dong Wu, Yugang Cheng, Qunzheng Wu; Analysis of data: all authors; Writing: Zhibo Yan, Guangyong Zhang; Critical revision: all authors; Final approval: all authors.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Statement of human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 9.López-Cano M, Serra-Aracil X, Mora L, Sánchez-García JL, Jiménez-Gómez LM, Martí M, Vallribera F, Fraccalvieri D, Serracant A, Kreisler E (2016) Preventing parastomal hernia using a modified sugarbaker technique with composite mesh during laparoscopic abdominoperineal resection: a randomized controlled trial. Ann Surg 264:923–928CrossRefPubMedGoogle Scholar