Skip to main content
SpringerLink
Log in

Laparoscopic Repair of Parastomal Hernias: A Single Surgeon’s Experience in 66 Patients

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Introduction

The repair of parastomal hernias represents a surgical problem with high complication and failure rates. A basic principle is the necessity of mesh-based techniques. The study was performed to evaluate a laparoscopic approach, primarily based on the intraperitoneal on lay mesh technique.

Methods

Sixty-six patients with a symptomatic parastomal hernia were enrolled in the prospective study between November 1999 and February 2006. After complete adhesiolysis, the mesh was introduced to cover the fascial defect of the hernia and the original midline incision. In special cases, a two-mesh technique was used. First, an incised mesh was placed around the stoma sling. The second mesh was used to cover the abdominal wall with the first mesh; the stoma sling was placed between the two meshes for at least 5 cm.

Results

The two-mesh technique proved to be superior in terms of recurrence rate especially in cases with a lateral fascial defect.

Conclusions

The laparoscopic repair of parastomal hernias is a surgically challenging procedure with promising results when using the two-mesh technique. Therefore, two meshes should be used in all cases of parastomal hernias. Polyvinylidene fluoride was revealed to be the most suitable material for the sandwich repair in terms of possible ingrowth and infection resistance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Leslie D. The parastomal hernia. Surg Clin North Am 1984;64:407–15.

    PubMed  CAS  Google Scholar 

  2. Pearl RK. Parastomal hernias. World J Surg 1989;13:569–72

    Article  PubMed  CAS  Google Scholar 

  3. Cheung MT. Complications of an abdominal stoma: an analysis of 322 stomas. Aust N Z J Surg 1995;65:808–11.

    CAS  Google Scholar 

  4. Bewes PC. Parastomal hernia. Ann R Coll Surg Engl 1997;79:154–5.

    PubMed  CAS  Google Scholar 

  5. Kasperk R, Willis S, Klinge U, Schumpelick V. Update on incisional hernia. Parastomal hernia. Chirurg 2002;73:895–8

    Article  PubMed  CAS  Google Scholar 

  6. Rubin MS, Schoetz DJ Jr, Matthews JB. Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 1994;129:413–8

    PubMed  CAS  Google Scholar 

  7. Cheung MT, Chia NH, Chiu WY. Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 2001;44:266–70.

    Article  PubMed  CAS  Google Scholar 

  8. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B. Collagen I/III and matrix metalloproteinase’s (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg 2001;14:47–54.

    Article  PubMed  CAS  Google Scholar 

  9. Klinge U, Conze J, Krones CJ, Schumpelick V. Incisional hernia: open techniques. World J Surg 2005;29:1066–72

    Article  PubMed  Google Scholar 

  10. Stephenson BM, Phillips RK. Parastomal hernia: local resiting and mesh repair. Br J Surg 1995;82:1395–6.

    Article  PubMed  CAS  Google Scholar 

  11. Martin L, Foster G. Parastomal hernia. Ann R Coll Surg Engl 1996;78:81–4.

    PubMed  CAS  Google Scholar 

  12. Morris-Stiff G, Hughes LE. The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl 1998;80:184–7.

    PubMed  CAS  Google Scholar 

  13. Tekkis PP, Kocher HM, Payne JG. Parastomal hernia repair: modified thorlakson technique, reinforced by polypropylene mesh. Dis Colon Rectum 1999;42:1505–8.

    Article  PubMed  CAS  Google Scholar 

  14. Kasperk R, Klinge U, Schumpelick V. The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg 2000;179:186–8.

    Article  PubMed  CAS  Google Scholar 

  15. Amin SN, Armitage NC, Abercrombie JF, Scholefield JH. Lateral repair of parastomal hernia. Ann R Coll Surg Engl 2001;83:206–8.

    PubMed  CAS  Google Scholar 

  16. White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias. Am Surg 1998;64:276–80.

    PubMed  CAS  Google Scholar 

  17. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg 2002;89:534–45.

    Article  PubMed  CAS  Google Scholar 

  18. Le Blanc KA. Incisional hernia repair: laparoscopic techniques. World J Surg 2005;29:1073–9.

    Article  Google Scholar 

  19. Sugarbaker PH. Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann Surg 1985;201:344–6.

    Article  PubMed  CAS  Google Scholar 

  20. 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;47:185–91.

    Article  PubMed  Google Scholar 

  21. LeBlanc KA, Bellanger DE. Laparoscopic repair of paraostomy hernias: early results. J Am Coll Surg 2002;194:232–9.

    Article  PubMed  Google Scholar 

  22. Le Blanc KA, Bellanger DE, Whitaker JM, Hausmann MG. Laparoscopic parastomal hernia repair. Hernia 2005;9:140–4.

    Article  CAS  Google Scholar 

  23. Voitk A. Simple technique for laparoscopic paracolostomy hernia repair. Dis Colon Rectum 2000;43:1451–3

    Article  PubMed  CAS  Google Scholar 

  24. Kozlowski PM, Wang PC, Winfield HN. Laparoscopic repair of incisional and parastomal hernias after major genitourinary or abdominal surgery. J Endourol 2001;15:175–9.

    Article  PubMed  CAS  Google Scholar 

  25. Safadi B. Laparoscopic repair of parastomal hernias: early results. Surg Endosc 2004;18:676–80.

    Article  PubMed  CAS  Google Scholar 

  26. Klinge U, Klosterhalfen B, Öttinger AP, Junge K, Schumpelick V. PVDF as a new polymer for the construction of surgical meshes. Biomaterials 2002;23:3487–93

    Google Scholar 

  27. Israelsson LA. Preventing and treating parastomal hernia. World J Surg 2005;29:1086–9.

    Article  PubMed  Google Scholar 

  28. Gonzalez R, Fugate K, McClusky D, et al. Relationship between tissue ingrowth and mesh contraction. World J Surg 2005;29:1038–43.

    Article  PubMed  Google Scholar 

  29. Johnson EK, Hoyt CH, Dinsmore RC. Abdominal wall hernia repair: a long-term comparison of Sepramesh and Dualmesh in a rabbit hernia model. Am Surg 2004;70:657–61.

    PubMed  Google Scholar 

  30. Leber GE, Garb JL, Alexander AI, Reed WP. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 1998;133:378–82.

    Article  PubMed  CAS  Google Scholar 

  31. DeMaria EJ, Moss JM, Sugarman HJ. Laparoscopic intraperitoneal polytetrafluorethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 2000;14:326–9.

    Article  PubMed  CAS  Google Scholar 

  32. Ladurner R, Mussack T. Small-bowel perforation due to protruding spiral tackers: a rare complication in laparoscopic incisional hernia repair. Surg Endosc 2004;18:1001.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Stadtklinik, Balgerstrasse 50, 76532, Baden-Baden, Germany

    Dieter Berger M.D. & Marc Bientzle M.D.

Authors
  1. Dieter Berger M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Bientzle M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dieter Berger M.D..

About this article

Cite this article

Berger, D., Bientzle, M. Laparoscopic Repair of Parastomal Hernias: A Single Surgeon’s Experience in 66 Patients. Dis Colon Rectum 50, 1668–1673 (2007). https://doi.org/10.1007/s10350-007-9028-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-007-9028-z

Key words

Search

Navigation