Advertisement

Parastomal and Lateral Defects

  • Ricardo Z. AbdallaEmail author
  • Thiago Nogueira Costa
  • Cassio Eduardo Silva Gontijo
Chapter

Abstract

Parastomal hernia is an intention hernia per se. It is supposed to permit a benign functionality for one dislodged bowel. The surgeon must consider all details to perform the procedure; it should be strategically planned and well completed (Sugarbaker, Surg Gynecol Obstet 169(1):75–77, 1989). Many hidden predisposing complication factors can be presented at the moment of a colostomy (Mylonakis et al., Colorectal Dis 3(5):334–337, 2001). This scenario is challenging when a parastomal hernia develops. The same analogy can be made for lateral defects that occur through drain incisions, closed stoma locations, surgical incisions, or others.

The incidence of major stoma complications could be considered as 46.4%; when minor problems are included that goes up to 56% (Nastro et al., Br J Surg 97(12):1885–1889, 2010). Hernias are likely to happen in 50% of the stomas, even ileostomy or colostomy (Fazekas et al., Ann R Coll Surg Engl 1–6, 2016). Despite the development of groups of clinical nurse stoma specialists, little can be done over parastomal hernias; of those, 10–15% will suffer occlusion, subocclusion, pain, or ischemia. This could be from the herniated tissue or the stoma bowel with various levels of consequences. Surgical options for correcting a parastomal hernia are local primary suturing repair, and relocation with or without mesh or muscle grafts, but the results are limited and poorly efficient with recurrences ranging from 46% to 100% (Israelsson, Surg Clin North Am 88(1):113–125, 2008; Allen-Mersh and Thomson, Br J Surg 75(5):416–418, 1988; Rubin et al., Arch Surg 129(4):413–418, 1994; Hansson et al., Ann Surg 255(4):685–695, 2012). The open suturing repair, with repositioning the ostomy must be abandoned (Hansson et al., Ann Surg 255(4):685–695, 2012). The use of mesh in parastomal hernia repair significantly reduces recurrence rates and is safe with a low overall rate of mesh infection (Geisler et al., Dis Colon Rectum 46(8):1118–1123, 2003). PTFEe mesh used to be the only option for these patients, but infection against the mesh compromises the whole surgery, with the occasional necessity to remove the mesh. In laparoscopic repair, the Sugarbaker technique is superior to the keyhole technique and shows fewer recurrences (Sugarbaker, Ann Surg 201(3):344–346, 1985). Lateral defects are not under those kinds of influence, but because of complexity of large flat muscles, they can have a unique behavior.

We must consider that most services dealing with ostomies are not familiar with hernia repair or even think of robotic use for this abdominal wall reconstruction. These patients have many comorbidities themselves with higher risks for multiple surgeries. The minimal robotic-assisted invasive surgery must be considered in these difficult cases. Mechanical arms can help the surgeon achieve a well-established dissection around the ostomy with the necessary torque to a good practice. It permits cleaning and returning to the cavity all protruded tissue exposing the abdominal wall anatomy details in the deep, noncontaminated field and because of defect recognition allows stitching the anterior aponeurosis, above the muscular layer and proceeding with the Sugarbaker technique in a better way, after defect closure. Some defects between muscles could be repaired by robot suturing superficial aponeurosis from the inside and positioning a preperitoneal mesh.

Keywords

Parastomal hernia Lateral abdominal wall hernia Wound ostomy care Stomal complications Ileostomy complications Colostomy complications Enterostomal therapy Wound ostomy continence Robotic incisional hernia repair Robotic transabdominal preperitoneal ventral hernia repair Robotic retromuscular ventral hernia repair Quality of life Cancer postoperative hernia complication Sugarbaker technique 

Supplementary material

Video 6.1

Parastomas Robot (MOV 3295088 kb)

References

  1. 1.
    Sugarbaker PH. Prevention of hernia after enterostomy. Surg Gynecol Obstet. 1989;169(1):75–7.PubMedGoogle Scholar
  2. 2.
    Mylonakis E, Scarpa M, Barollo M, Yarnoz C, Keighley MR. Life table analysis of hernia following end colostomy construction. Color Dis. 2001;3(5):334–7.CrossRefGoogle Scholar
  3. 3.
    Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ. Complications of intestinal stomas. Br J Surg. 2010;97(12):1885–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Fazekas B, Fazekas B, Hendricks J, Smart N, Arulampalam T. The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection. Ann R Coll Surg Engl 2017;99(4):319–324.Google Scholar
  5. 5.
    Israelsson LA. Parastomal hernias. Surg Clin North Am. 2008;88(1):113–25. ixCrossRefPubMedGoogle Scholar
  6. 6.
    Allen-Mersh TG, Thomson JP. Surgical treatment of colostomy complications. Br J Surg. 1988;75(5):416–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Rubin MS, Schoetz DJ Jr, Matthews JB. Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg. 1994;129(4):413–8. discussion 8–9CrossRefPubMedGoogle Scholar
  8. 8.
    Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, et al. Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg. 2012;255(4):685–95.CrossRefPubMedGoogle Scholar
  9. 9.
    Geisler DJ, Reilly JC, Vaughan SG, Glennon EJ, Kondylis PD. Safety and outcome of use of nonabsorbable mesh for repair of fascial defects in the presence of open bowel. Dis Colon Rectum. 2003;46(8):1118–23.CrossRefPubMedGoogle Scholar
  10. 10.
    Sugarbaker PH. Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann Surg. 1985;201(3):344–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Carne PW, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg. 2003;90(7):784–93.CrossRefPubMedGoogle Scholar
  12. 12.
    Misiakos EP, Machairas A, Patapis P, Liakakos T. Laparoscopic ventral hernia repair: pros and cons compared with open hernia repair. JSLS. 2008;12(2):117–25.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Gillern S, Bleier JI. Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials. Clin Colon Rectal Surg. 2014;27(4):162–71.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc. 1993;3(1):39–41.PubMedGoogle Scholar
  15. 15.
    LeBlanc KA, Booth WV. Avoiding complications with laparoscopic herniorrhaphy. Surg Laparosc Endosc. 1993;3(5):420–4.PubMedGoogle Scholar
  16. 16.
    Baucom RB, Beck WC, Holzman MD, Sharp KW, Nealon WH, Poulose BK. The importance of surgeon-reviewed computed tomography for incisional hernia detection: a prospective study. Am Surg. 2014;80(7):720–2.PubMedGoogle Scholar
  17. 17.
    Baucom RB, Beck WC, Phillips SE, Holzman MD, Sharp KW, Nealon WH, et al. Comparative evaluation of dynamic abdominal sonography for hernia and computed tomography for characterization of incisional hernia. JAMA Surg. 2014;149(6):591–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Machairas A, Liakakos T, Patapis P, Petropoulos C, Tsapralis D, Misiakos EP. Prosthetic repair of incisional hernia combined with elective bowel operation. Surgeon. 2008;6(5):274–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Carlsson E, Fingren J, Hallen AM, Petersen C, Lindholm E. The prevalence of ostomy-related complications 1 year after ostomy surgery: a prospective, descriptive. Clin Stud Ostomy Wound Manag. 2016;62(10):34–48.Google Scholar
  20. 20.
    Ibarra-Hurtado TR, Nuno-Guzman CM. Comment to: chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen by Zielinski et al. Hernia. 2013;17(1):109–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Ibarra-Hurtado TR, Nuno-Guzman CM, Echeagaray-Herrera JE, Robles-Velez E, de Jesus Gonzalez-Jaime J. Use of botulinum toxin type a before abdominal wall hernia reconstruction. World J Surg. 2009;33(12):2553–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Ibarra-Hurtado TR, Nuno-Guzman CM, Miranda-Diaz AG, Troyo-Sanroman R, Navarro-Ibarra R, Bravo-Cuellar L. Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia. 2014;18(5):647–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Farooque F, Jacombs AS, Roussos E, Read JW, Dardano AN, Edye M, et al. Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair. ANZ J Surg. 2016;86(1–2):79–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Blair LJ, Ross SW, Huntington CR, Watkins JD, Prasad T, Lincourt AE, et al. Computed tomographic measurements predict component separation in ventral hernia repair. J Surg Res. 2015;199(2):420–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Chang FH, Lee CL, Soong YK. Use of Palmer’s point for insertion of the operative laparoscope in patients with severe pelvic adhesions: experience of seventeen cases. J Am Assoc Gynecol Laparosc. 1994;1(4, Part 2):S7.CrossRefPubMedGoogle Scholar
  26. 26.
    Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13(1):1–5.PubMedGoogle Scholar
  27. 27.
    Schoonderwoerd L, Swank DJ. The role of optical access trocars in laparoscopic surgery. Surg Technol Int. 2005;14:61–7.PubMedGoogle Scholar
  28. 28.
    Bellon JM. Letter 1: adverse effects of polyvinylidene fluoride-coated polypropylene mesh used for laparoscopic intraperitoneal onlay repair of incisional hernia. Br J Surg. 2010;97:1140–5. Br J Surg. 2011;98(1):158-9; author reply 60CrossRefGoogle Scholar
  29. 29.
    Klosterhalfen B. Letter 2: adverse effects of polyvinylidene fluoride-coated polypropylene mesh used for laparoscopic intraperitoneal onlay repair of incisional hernia. Br J Surg. 2010;97:1140–5. Br J Surg. 2011;98(1):159–60; author reply 60CrossRefGoogle Scholar
  30. 30.
    Berger D, Bientzle M. Polyvinylidene fluoride: a suitable mesh material for laparoscopic incisional and parastomal hernia repair! A prospective, observational study with 344 patients. Hernia. 2009;13(2):167–72.CrossRefPubMedGoogle Scholar
  31. 31.
    d’Acampora AJ, Joli FS, Tramonte R. Expanded polytetrafluoroethylene and polypropylene in the repairing of abdominal wall defects in Wistar rats. Comparative study. Acta Cir Bras. 2006;21(6):409–15.CrossRefPubMedGoogle Scholar
  32. 32.
    DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Dennis RG, Kuzon WM Jr, Franz MG. Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg. 2007;245:140–6.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Hauters P, Desmet J, Gherardi D, Dewaele S, Poilvache H, Malvaux P. Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc. 2017. doi: 10.1007/s00464-016-5401-0. [Epub ahead of print]Google Scholar
  34. 34.
    Tandon A, Pathak S, Lyons NJ, Nunes QM, Daniels IR, Smart NJ. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg. 2016 Nov;103(12):1598–607.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Ricardo Z. Abdalla
    • 1
    • 2
    Email author
  • Thiago Nogueira Costa
    • 1
    • 2
  • Cassio Eduardo Silva Gontijo
    • 3
  1. 1.Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil
  2. 2.Sao Paulo Cancer Institute at University of Sao PauloSão PauloBrazil
  3. 3.University of São Paulo School of MedicineSão PauloBrazil

Personalised recommendations