Abstract
Introduction
Parastomal hernias are a complex surgical problem affecting a large number of patients. Recurrences continue to occur despite various methods of repair. We present a novel method of open parastomal hernia repair with retromuscular mesh reinforcement in a modified Sugarbaker configuration.
Methods
A full mildline laparotomy is performed and all adhesions are taken down. We then perform an open parastomal hernia repair by utilizing retromuscular dissection, posterior component separation via transversus abdominis release, and lateralization of the bowel utilizing a modified Sugarbaker mesh configuration within the retromuscular space. We demonstrate this technique in a cadaveric model for illustrative purposes.
Discussion
This repair provides the benefits of an open posterior component separation with transversus abdominis release and maintains the biomechanics of a functional abdominal wall, all while simultaneously benefitting from the advantages of mesh reinforcement in a modified Sugarbaker configuration. Our clinical experience with this novel technique to this point has been positive.
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References
Al Shakarchi J, Williams JG (2014) Systematic review of open techniques for parastomal hernia repair. Tech Coloproctol 18(5):427–432. doi:10.1007/s10151-013-1110-z
Hotouras A, Murphy J, Power N, Williams NS, Chan CL (2013) Radiological incidence of parastomal herniation in cancer patients with permanent colostomy: what is the ideal size of the surgical aperture? Int J Surg 11(5):425–427. doi:10.1016/j.ijsu.2013.03.010
Israelsson LA (2008) Parastomal hernias. The Surgical clinics of North America 88(1):113–125, ix. doi:10.1016/j.suc.2007.10.003
Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ (2010) Complications of intestinal stomas. Br J Surg 97(12):1885–1889. doi:10.1002/bjs.7259
Rieger N, Moore J, Hewett P, Lee S, Stephens J (2004) Parastomal hernia repair. Colorectal Dis Off J Assoc Coloproctol Great Britain Ireland 6(3):203–205. doi:10.1111/j.1463-1318.2004.00587.x
Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255(4):685–695. doi:10.1097/SLA.0b013e31824b44b1
Horgan K, Hughes LE (1986) Para-ileostomy hernia: failure of a local repair technique. Br J Surg 73(6):439–440
Rubin MS, Schoetz DJ Jr, Matthews JB (1994) Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 129(4):413–418 discussion 418-419
Raigani S, Criss CN, Petro CC, Prabhu AS, Novitsky YW, Rosen MJ (2014) Single-center experience with parastomal hernia repair using retromuscular mesh placement. J Gastrointest Surg Off J Soc Surg Aliment Tract 18(9):1673–1677. doi:10.1007/s11605-014-2575-4
Novitsky YW, Harrell AG, Cristiano JA, Paton BL, Norton HJ, Peindl RD, Kercher KW, Heniford BT (2007) Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit. J Surg Res 140(1):6–11. doi:10.1016/j.jss.2006.09.015
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EMP declares conflict of interest not directly associated with this work. EMP is a speaker for Cook Biotech inc. and Gore and is participating in clinical trials for Cook Biotech inc. and Miromatrix. RMJ declares no conflict of interest. JSW declares no conflict of interest.
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Pauli, E.M., Juza, R.M. & Winder, J.S. How I do it: novel parastomal herniorrhaphy utilizing transversus abdominis release. Hernia 20, 547–552 (2016). https://doi.org/10.1007/s10029-016-1489-3
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DOI: https://doi.org/10.1007/s10029-016-1489-3