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Parastomal hernia repair outcomes in relation to stoma site with diisocyanate cross-linked acellular porcine dermal collagen mesh

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Abstract

Purpose

Biologic meshes are increasingly used in parastomal hernia repair. This study evaluates the efficacy and safety of diisocyanate cross-linked acellular porcine dermal collagen mesh for parastomal hernia repair, with particular reference to the relationship of the stoma site to the rectus sheath.

Methods

Hernias were repaired via a lateral approach, with onlay placement of the biologic mesh. A retrospective case note review and analysis of clinical outcomes was performed. The relationship of the stoma to the rectus sheath was determined by abdominal computed tomography (CT) and intraoperative findings.

Results

Over a 16-month period, 27 consecutive patients, median age 72 years, underwent parastomal hernia repair utilising onlay biologic mesh to reinforce the external oblique aponeurosis. There were 20 paracolostomy and seven paraileostomy hernias. Eleven stomas passed through the rectus sheath and 16 were lateral to it. Recurrences occurred in 3 of 11 stomas within and 12 of 16 stomas lateral to the rectus sheath (P = 0.022). The median time to recurrence was 10.1 months. The median follow up of patients without recurrence was 16.6 months (range 0.2–39.3). There was one perioperative death. One patient developed a superficial post-operative abscess that was managed conservatively, but there were no complications related to the biologic mesh and no mesh required removal.

Conclusions

For parastomal hernias within the rectus sheath, diisocyanate cross-linked porcine dermal collagen mesh onlay repair gives good results and is safe to use. Repair of a parastomal hernia where the stoma is lateral to the rectus sheath has a significantly higher risk of recurrence and is not recommended.

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References

  1. Pearl RK (1989) Parastomal hernias. World J Surg 13:569–572

    Article  PubMed  CAS  Google Scholar 

  2. Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793

    Article  PubMed  CAS  Google Scholar 

  3. Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37:916–920

    Article  PubMed  CAS  Google Scholar 

  4. Porter JA, Salvati EP, Rubin RJ, Eisenstat TE (1989) Complications of colostomies. Dis Colon Rectum 32:299–303

    Article  PubMed  CAS  Google Scholar 

  5. Shellito PC (1998) Complications of abdominal stoma surgery. Dis Colon Rectum 41:1562–1572

    Article  PubMed  CAS  Google Scholar 

  6. Shabbir J, Britton DC (2010) Stoma complications: a literature overview. Colorectal Dis 12:958–964

    Article  PubMed  CAS  Google Scholar 

  7. Israelsson LA (2005) Preventing and treating parastomal hernia. World J Surg 29(8):1086–1089

    Article  PubMed  Google Scholar 

  8. 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):2723–2729

    Article  PubMed  Google Scholar 

  9. Hammond TM, Huang A, Prosser K, Frye JN, Williams NS (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12(5):475–481

    Article  PubMed  CAS  Google Scholar 

  10. Jänes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33(1):118–121

    Article  PubMed  Google Scholar 

  11. Jänes A, Cengiz Y, Israelsson LA (2010) Experiences with a prophylactic mesh in 93 consecutive ostomies. World J Surg 34(7):1637–1640

    Article  PubMed  Google Scholar 

  12. Stephenson BM, Evans MD, Hilton J, McKain ES, Williams GL (2010) Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positioned stoma (LRAPS). Colorectal Dis 12:1049–1052

    Article  PubMed  CAS  Google Scholar 

  13. Rosin JD, Bonardi RA (1977) Paracolostomy hernia repair with Marlex mesh: a new technique. Dis Colon Rectum 20:299–302

    Article  PubMed  CAS  Google Scholar 

  14. Sugarbaker PH (1980) Prosthetic mesh repair of large hernias at the site of colonic stomas. Surg Gynecol Obstet 150:576–578

    PubMed  CAS  Google Scholar 

  15. Ellis CN (2010) Short-term outcomes with the use of bioprosthetics for the management of parastomal hernias. Dis Colon Rectum 53(3):279–283

    Article  PubMed  Google Scholar 

  16. Aldridge AJ, Simson JN (2001) Erosion and perforation of colon by synthetic mesh in a recurrent paracolostomy hernia. Hernia 5(2):110–112

    Article  PubMed  CAS  Google Scholar 

  17. Kelly ME, Behrman SW (2002) The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds. Am Surg 68(6):524–528

    PubMed  Google Scholar 

  18. Steele SR, Lee P, Martin MJ, Mullenix PS, Sullivan ES (2003) Is parastomal hernia repair with polypropylene mesh safe? Am J Surg 185(5):436–440

    Article  PubMed  Google Scholar 

  19. Lüning TH, Spillenaar-Bilgen EJ (2009) Parastomal hernia: complications of extra-peritoneal onlay mesh placement. Hernia 13:487–490

    Article  PubMed  Google Scholar 

  20. Cingi A, Cakir T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563

    Article  PubMed  Google Scholar 

  21. Kish KJ, Buinewicz BR, Morris JB (2005) Acellular dermal matrix (AlloDerm): new material in the repair of stoma site hernias. Am Surg 71(12):1047–1050

    PubMed  Google Scholar 

  22. Aycock J, Fichera A, Colwell JC, Song DH (2007) Parastomal hernia repair with acellular dermal matrix. J Wound Ostomy Continence Nurs 34(5):521–523

    Article  PubMed  Google Scholar 

  23. Taner T, Cima RR, Larson DW, Dozois EJ, Pemberton JH, Wolff BG (2009) 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 52(2):349–354

    Article  PubMed  Google Scholar 

  24. Franklin ME Jr, Treviño JM, Portillo G, Vela I, Glass JL, González JJ (2008) 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 22(9):1941–1946

    Article  PubMed  Google Scholar 

  25. Lochan R, Slater BJ, Goulbourne IA (2003) Parastomal hernia. Br J Surg 90(10):1306

    Article  PubMed  CAS  Google Scholar 

  26. Inan I, Gervaz P, Hagen M, Morel P (2007) Multimedia article. Laparoscopic repair of parastomal hernia using a porcine dermal collagen (Permacol) implant. Dis Colon Rectum 50(9):1465

    Article  PubMed  Google Scholar 

  27. Loganathan A, Ainslie WG, Wedgwood KR (2010) Initial evaluation of Permacol bioprosthesis for the repair of complex incisional and parastomal hernias. Surgeon 8(4):202–205

    Article  PubMed  CAS  Google Scholar 

  28. Greenstein AJ, Aldoroty RA (2008) Parastomal hernia repair using cross-linked porcine dermis: report of a case. Surg Today 38(11):1048–1051

    Article  PubMed  Google Scholar 

  29. Rosen MJ, Reynolds HL, Champagne B, Delaney CP (2010) A novel approach for the simultaneous repair of large midline incisional and parastomal hernias with biological mesh and retrorectus reconstruction. Am J Surg 199(3):416–420

    Article  PubMed  Google Scholar 

  30. Araujo SE, Habr-Gama A, Teixeira MG, Caravatto PP, Kiss DR, Gama-Rodrigues J (2005) Role of biological mesh in surgical treatment of paracolostomy hernias. Clinics (Sao Paulo) 60(4):271–276

    Google Scholar 

  31. Lo Menzo E, Martinez JM, Spector SA, Iglesias A, Degennaro V, Cappellani A (2008) Use of biologic mesh for a complicated paracolostomy hernia. Am J Surg 196(5):715–719

    Article  PubMed  Google Scholar 

  32. Wietfeldt ED, Hassan I, Rakinic J (2009) Utilization of bovine acellular dermal matrix for abdominal wall reconstruction: a retrospective case series. Ostomy Wound Manage 55(8):52–56

    PubMed  Google Scholar 

  33. Hiles M, Record Ritchie RD, Altizer AM (2009) Are biologic grafts effective for hernia repair? A systematic review of the literature. Surg Innov 16(1):26–37

    Article  PubMed  Google Scholar 

  34. Hammond TM, Chin-Aleong J, Navsaria H, Williams NS (2008) Human in vivo cellular response to a cross-linked acellular collagen implant. Br J Surg 95(4):438–446

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

IRD and NJS have received financial support from Covidien to attend surgical conferences and grants for medical research.

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Authors and Affiliations

  1. Exeter Colorectal Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK

    N. J. Smart, R. Velineni, D. Khan & I. R. Daniels

Authors
  1. N. J. Smart
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  2. R. Velineni
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  3. D. Khan
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  4. I. R. Daniels
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Corresponding author

Correspondence to I. R. Daniels.

Additional information

Earlier versions of this data have been presented at the 5th Annual Meeting of the European Society of Coloproctology (ESCP), Sorrento, Italy, September 2010, and has appeared in abstract form as Velineni R, Smart N, Daniels I. Rectus abdominis: the key to success of parastomal hernia repair. Colorectal Disease 2010;12(Suppl 3):P074.

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Smart, N.J., Velineni, R., Khan, D. et al. Parastomal hernia repair outcomes in relation to stoma site with diisocyanate cross-linked acellular porcine dermal collagen mesh. Hernia 15, 433–437 (2011). https://doi.org/10.1007/s10029-011-0791-3

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  • DOI: https://doi.org/10.1007/s10029-011-0791-3

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