Advertisement

Treatment of Parastomal Hernias

  • Zachary Sanford
  • Adam S. Weltz
  • Igor BelyanskyEmail author
Chapter

Abstract

Parastomal hernias are a dreaded yet common complication following the creation of a surgical stoma. Their repair represents a significant surgical challenge as the presence of functional bowel passing through the abdominal wall by means of an iatrogenic defect makes fascial continuity impossible to restore. Although surgical intervention was once associated with high rates of recurrence and significant postoperative complications, modern techniques for parastomal hernia repair through incorporation of mesh reinforcement and minimally invasive procedures have brought about improvements in the perioperative and postoperative course.

Keywords

Surgical stoma Parastomal hernias Hernia formation Stoma relocation Primary repair Parastomal hernia mesh repair Onlay mesh Underlay mesh Transversus abdominis release Modified retrorectus Sugarbaker 

References

  1. 1.
    Shabbir J, Britton DC. Stoma complications: a literature overview. Color Dis. 2010;12(10):958–64.CrossRefGoogle Scholar
  2. 2.
    Janes A, Cengiz Y, Israelsson LA. Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg. 2004;91(3):280–2.CrossRefGoogle Scholar
  3. 3.
    Farnham SB, Cookson MS. Surgical complications of urinary diversion. World J Urol. 2004;22(3):157–67.CrossRefGoogle Scholar
  4. 4.
    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
  5. 5.
    Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum. 1994;37(9):916–20.CrossRefGoogle Scholar
  6. 6.
    Robertson I, Leung E, Hughes D, et al. Prospective analysis of stoma-related complications. Color Dis. 2005;7(3):279–85.CrossRefGoogle Scholar
  7. 7.
    Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP. Stoma complications: a multivariate analysis. Am Surg. 2002;68(11):961–6; discussion 966.PubMedGoogle Scholar
  8. 8.
    Raftopoulos I, Vanuno D, Khorsand J, Ninos J, Kouraklis G, Lasky P. Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size. J Laparoendosc Adv Surg Tech A. 2002;12(6):425–9.CrossRefGoogle Scholar
  9. 9.
    Birgisson G, Park AE, Mastrangelo MJ Jr, Witzke DB, Chu UB. Obesity and laparoscopic repair of ventral hernias. Surg Endosc. 2001;15(12):1419–22.CrossRefGoogle Scholar
  10. 10.
    Tadeo-Ruiz G, Picazo-Yeste JS, Moreno-Sanz C, Herrero-Bogajo ML. [Parastomal hernias: background, current status and future prospects]. Cir Esp. 2010;87(6):339–49.CrossRefGoogle Scholar
  11. 11.
    Williams JG, Etherington R, Hayward MW, Hughes LE. Paraileostomy hernia: a clinical and radiological study. Br J Surg. 1990;77(12):1355–7.CrossRefGoogle Scholar
  12. 12.
    Cingi A, Cakir T, Sever A, Aktan AO. Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum. 2006;49(10):1559–63.CrossRefGoogle Scholar
  13. 13.
    Israelsson LA. Parastomal hernias. Surg Clin North Am. 2008;88(1):113–25, ix.CrossRefGoogle Scholar
  14. 14.
    Carne PW, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg. 2003;90(7):784–93.CrossRefGoogle Scholar
  15. 15.
    Riansuwan W, Hull TL, Millan MM, Hammel JP. Surgery of recurrent parastomal hernia: direct repair or relocation? Color Dis. 2010;12(7):681–6.CrossRefGoogle Scholar
  16. 16.
    Botet X, Boldo E, Llaurado JM. Colonic parastomal hernia repair by translocation without formal laparotomy. Br J Surg. 1996;83(7):981.CrossRefGoogle Scholar
  17. 17.
    Kaufman JJ. Repair of parastomal hernia by translocation of the stoma without laparotomy. J Urol. 1983;129(2):278–9.CrossRefGoogle Scholar
  18. 18.
    Taylor RL Jr, Rombeau JL, Turnbull RB Jr. Transperitoneal relocation of the ileal stoma without formal laparotomy. Surg Gynecol Obstet. 1978;146(6):953–8.PubMedGoogle Scholar
  19. 19.
    Cheung MT, Chia NH, Chiu WY. Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum. 2001;44(2):266–70.CrossRefGoogle Scholar
  20. 20.
    Baig MK, Larach JA, Chang S, et al. Outcome of parastomal hernia repair with and without midline laparotomy. Tech Coloproctol. 2006;10(4):282–6.CrossRefGoogle Scholar
  21. 21.
    Allen-Mersh TG, Thomson JP. Surgical treatment of colostomy complications. Br J Surg. 1988;75(5):416–8.CrossRefGoogle Scholar
  22. 22.
    Rubin MS, Schoetz DJ Jr, Matthews JB. Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg. 1994;129(4):413–8; discussion 418–419.CrossRefGoogle Scholar
  23. 23.
    Martin L, Foster G. Parastomal hernia. Ann R Coll Surg Engl. 1996;78(2):81–4.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Horgan K, Hughes LE. Para-ileostomy hernia: failure of a local repair technique. Br J Surg. 1986;73(6):439–40.CrossRefGoogle Scholar
  25. 25.
    Morris-Stiff GJ, Hughes LE. The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg. 1998;186(3):352–67.CrossRefGoogle Scholar
  26. 26.
    Ballas KD, Rafailidis SF, Marakis GN, Pavlidis TE, Sakadamis AK. Intraperitoneal ePTFE mesh repair of parastomal hernias. Hernia. 2006;10(4):350–3.CrossRefGoogle Scholar
  27. 27.
    Abaza R, Perring P, Sferra JJ. Novel parastomal hernia repair using a modified polypropylene and PTFE mesh. J Am Coll Surg. 2005;201(2):316–7.CrossRefGoogle Scholar
  28. 28.
    White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias. Am Surg. 1998;64(3):276–80.PubMedGoogle Scholar
  29. 29.
    Hiles M, Record Ritchie RD, Altizer AM. Are biologic grafts effective for hernia repair?: A systematic review of the literature. Surg Innov. 2009;16(1):26–37.CrossRefGoogle Scholar
  30. 30.
    Franklin ME Jr, Trevino JM, Portillo G, Vela I, Glass JL, Gonzalez JJ. The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up. Surg Endosc. 2008;22(9):1941–6.CrossRefGoogle Scholar
  31. 31.
    Greenstein AJ, Aldoroty RA. Parastomal hernia repair using cross-linked porcine dermis: report of a case. Surg Today. 2008;38(11):1048–51.CrossRefGoogle Scholar
  32. 32.
    Taner T, Cima RR, Larson DW, Dozois EJ, Pemberton JH, Wolff BG. The use of human acellular dermal matrix for parastomal hernia repair in patients with inflammatory bowel disease: a novel technique to repair fascial defects. Dis Colon Rectum. 2009;52(2):349–54.CrossRefGoogle Scholar
  33. 33.
    Keller JE, Dolce CJ, Walters KC, et al. Effect of bacterial exposure on acellular human dermis in a rat ventral hernia model. J Surg Res. 2010;162(1):148–52.CrossRefGoogle Scholar
  34. 34.
    Belyansky I, Tsirline VB, Martin TR, et al. The addition of lysostaphin dramatically improves survival, protects porcine biomesh from infection, and improves graft tensile shear strength. J Surg Res. 2011;171(2):409–15.CrossRefGoogle Scholar
  35. 35.
    Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix—an expensive hernia sac. Am J Surg. 2008;196(1):47–50.CrossRefGoogle Scholar
  36. 36.
    Pauli EM, Juza RM, Winder JS. How I do it: novel parastomal herniorrhaphy utilizing transversus abdominis release. Hernia. 2016;20(4):547–52.CrossRefGoogle Scholar
  37. 37.
    Belyansky I, Sanford Z, Weltz AS. Robotic Parastomal Hernia Repair: Modified Sugarbaker Repair. In: Kudsi OY, Tsuda S, eds. Atlas of Robotic Surgery. 1st ed. Woodbury (CT): Cine-Med, Inc; 2018.Google Scholar
  38. 38.
    Rosen MJ, Bauer JJ, Harmaty M, et al. Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg. 2017;265(1):205–11.CrossRefGoogle Scholar
  39. 39.
    Majumder A, Winder JS, Wen Y, Pauli EM, Belyansky I, Novitsky YW. Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery. 2016;160(4):828–38.CrossRefGoogle Scholar
  40. 40.
    Stelzner S, Hellmich G, Ludwig K. Repair of paracolostomy hernias with a prosthetic mesh in the intraperitoneal onlay position: modified Sugarbaker technique. Dis Colon Rectum. 2004;47(2):185–91.CrossRefGoogle Scholar
  41. 41.
    van Sprundel TC, Gerritsen van der Hoop A. Modified technique for parastomal hernia repair in patients with intractable stoma-care problems. Color Dis. 2005;7(5):445–9.CrossRefGoogle Scholar
  42. 42.
    Hansson BM, Slater NJ, van der Velden AS, et al. Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg. 2012;255(4):685–95.CrossRefGoogle Scholar
  43. 43.
    Morris-Stiff G, Hughes LE. The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl. 1998;80(3):184–7.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Porcheron J, Payan B, Balique JG. Mesh repair of paracolostomal hernia by laparoscopy. Surg Endosc. 1998;12(10):1281.CrossRefGoogle Scholar
  45. 45.
    Rosin JD, Bonardi RA. Paracolostomy hernia repair with Marlex mesh: a new technique. Dis Colon Rectum. 1977;20(4):299–302.CrossRefGoogle Scholar
  46. 46.
    Leslie D. The parastomal hernia. Aust N Z J Surg. 1981;51(5):485–6.CrossRefGoogle Scholar
  47. 47.
    Leslie D. The parastomal hernia. Surg Clin North Am. 1984;64(2):407–15.CrossRefGoogle Scholar
  48. 48.
    Tekkis PP, Kocher HM, Payne JG. Parastomal hernia repair: modified thorlakson technique, reinforced by polypropylene mesh. Dis Colon Rectum. 1999;42(11):1505–8.CrossRefGoogle Scholar
  49. 49.
    Tekkis PP, Kocher HM, Payne JG. The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl. 1999;81(2):140–1.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Sugarbaker PH. Prosthetic mesh repair of large hernias at the site of colonic stomas. Surg Gynecol Obstet. 1980;150(4):576–8.PubMedGoogle Scholar
  51. 51.
    Sugarbaker PH. Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann Surg. 1985;201(3):344–6.CrossRefGoogle Scholar
  52. 52.
    LeBlanc KA, Bellanger DE. Laparoscopic repair of paraostomy hernias: early results. J Am Coll Surg. 2002;194(2):232–9.CrossRefGoogle Scholar
  53. 53.
    Hansson BM, Bleichrodt RP, de Hingh IH. Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate. Surg Endosc. 2009;23(7):1456–9.CrossRefGoogle Scholar
  54. 54.
    Safadi B. Laparoscopic repair of parastomal hernias: early results. Surg Endosc. 2004;18(4):676–80.CrossRefGoogle Scholar
  55. 55.
    Hansson BM, de Hingh IH, Bleichrodt RP. Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients. Surg Endosc. 2007;21(6):989–93.CrossRefGoogle Scholar
  56. 56.
    Majumder A, Orenstein SB, Miller HJ, Novitsky YW. Stapled transabdominal ostomy reinforcement with retromuscular mesh (STORRM): technical details and early outcomes of a novel approach for retromuscular repair of parastomal hernias. Am J Surg. 2018;215(1):82–7.CrossRefGoogle Scholar
  57. 57.
    Williams NS, Hotouras A, Bhan C, Murphy J, Chan CL. A case-controlled pilot study assessing the safety and efficacy of the Stapled Mesh stomA Reinforcement Technique (SMART) in reducing the incidence of parastomal herniation. Hernia. 2015;19(6):949–54.CrossRefGoogle Scholar
  58. 58.
    Sjodahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma. Br J Surg. 1988;75(4):339–41.CrossRefGoogle Scholar
  59. 59.
    Bayer I, Kyzer S, Chaimoff C. A new approach to primary strengthening of colostomy with Marlex mesh to prevent paracolostomy hernia. Surg Gynecol Obstet. 1986;163(6):579–80.PubMedGoogle Scholar
  60. 60.
    Biswas A, Marimuthu K, Mathew G. Prevention of parastomal hernia using pre-peritoneal mesh—long term outcome of a prospective study. Acta Chir Belg. 2015;115:15–9.CrossRefGoogle Scholar
  61. 61.
    Gogenur I, Mortensen J, Harvald T, Rosenberg J, Fischer A. Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation. Dis Colon Rectum. 2006;49(8):1131–5.CrossRefGoogle Scholar
  62. 62.
    Helgstrand F, Gogenur I, Rosenberg J. Prevention of parastomal hernia by the placement of a mesh at the primary operation. Hernia. 2008;12(6):577–82.CrossRefGoogle Scholar
  63. 63.
    Janes A, Cengiz Y, Israelsson LA. Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg. 2009;33(1):118–21; discussion 113–122.CrossRefGoogle Scholar
  64. 64.
    Light HG. A secure end colostomy technique. Surg Gynecol Obstet. 1992;174(1):67–8.PubMedGoogle Scholar
  65. 65.
    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.CrossRefGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  • Zachary Sanford
    • 1
  • Adam S. Weltz
    • 1
  • Igor Belyansky
    • 1
    Email author
  1. 1.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA

Personalised recommendations