Repair of Paracolostomy Hernias With a Prosthetic Mesh in the Intraperitoneal Onlay Position: Modified Sugarbaker Technique

PURPOSE: The disappointing outcome of local fascial repair and stoma relocation in parastomal hernias has stimulated a variety of new techniques that use a prosthetic mesh for herniorrhaphy. Many of these procedures either carry the risk of mesh contamination or allow only a local repair. We established a method that allows both an aseptic operation and the management of concurrent incisional hernias. METHODS: In a retrospective study we evaluated all patients who had undergone operation for a paracolostomy hernia with an expanded polytetrafluoroethylene (PTFE) mesh in the intraperitoneal onlay position in our Department of General Surgery from 1994 until 2002. Twenty patients with large paracolostomy hernias and 10 additional ventral hernias, mostly large incisional or recurrent incisional hernias, were identified. We combined the Sugarbaker and the Rives-Stoppa techniques by covering the defects with an ePTFE mesh after laparotomy and fixing the mesh with traction sutures. RESULTS: Postoperatively, there was no incidence of mesh infection. After a mean follow-up of 3½ years we found three recurrences of paracolostomy hernias and two recurrences of incisional hernias. Another two hernias emerged in the previously intact midline. All these hernias were small, without tendency to enlargement, and did not warrant reoperation. CONCLUSIONS: Patients with symptomatic paracolostomy hernias or a combination of abdominal wall defects should properly be managed surgically with an intraperitoneally placed mesh that covers all hernias. Our results, with a recurrence rate of only 15 percent for the parastomal site and 20 percent for combined defects, support this approach.