Parostomal Hernia: A More and More Frequent Surgical Challenge

Juan Antonio Martín Cartes, Manuel Bustos-Jiménez and María Jesús Tamayo-López

Department of Surgery, University of Seville, Spain

^*Correspondance to: Juan Antonio Mart�n 

 PDF  Full Text DOI: 10.25107/2474-1647.1960

Abstract

Repairing Paro Stomal Hernias (PSH) can be considered an interesting challenge. Primary closure of those hernias is often not possible. There is little agreement about the most appropriate technique or prosthetic to repair these defects, in spite the fact of the prevalence of them. Moreover, despite being contaminated surgical fields, we are almost always faced to reinforce with prosthetic meshes. PSH is one of the most common complications following stoma creation and its prevalence is only expected to increase. It often leads to a decrease in the quality of life for patients due to discomfort, pain, frequent ostomy appliance leakage, or peristomal skin irritation and can result in significantly increased healthcare costs. Surgical technique for PSH repair has evolved significantly over the past two decades with the introduction of new types of mesh and laparoscopic procedures. The use of prophylactic mesh in high-risk patients at the time of stoma creation has gained attention in lieu of several promising studies that have emerged in the recent days. This review will attempt to provide an overview of the current management and surgical techniques at both preventing and treating PSH hernias. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures.Materials and
Methods: We reviewed the records of 60 patients who underwent surgery after having been suffering from PSH from 2011 to 2015. Follow-up (median 37 months) was available for all of them. Of the 60 patients 12 had previously undergone an ileal conduit (Bricker’s procedure) diversion, 6 an end ileostomy and the 48 remaining patients a terminal colectomy. Patients were followed with computerized tomography surveillance. Standardized criteria were used to define parostomal and incisional hernias by an expert radiologist. They underwent an eventroplasty with Dynamesh IPST implant (FEG Textiltechnik, Aachen, Germany), which is a 3-dimensional pre shaped, open-pore and monofilament mesh consisting of Poly Vinyli Dene Fluoride (PVDF) and polypropylene.Results: PSH was diagnosed in 60 patients with a mean age at diagnosis of 66.5 years. Eleven patients had associated an incisional hernia. 66 (54.5%) of patients with PSH were male. Mean body mass index was 35.5kg/m². Mean parastomal defect size was 9.88 (range 4-13 cm). In 55 patients (91.66%) PSH were clinically and radiologically evident. Five patients (8.33%) included in this series recurred with PSH; Five patients (8.33%) included in this series recurred with PSH; so far, we have succeeded in folding out and attaching again the mesh we had previously used in order to work those problems out. Those recurrences were diagnosed 12-24 months after the date of the operation.Conclusion: In this review, we describe the clinical and radiographic definitions of PSH, the clinical impact and risk factors associated with its development, and the use of a 3-dimensional pre-shaped mesh so that we can work these hernias out.

Keywords

Cite the article

Cartes JAM, Bustos-Jim�nez M, Tamayo-L�pez MJ. Parostomal Hernia: A More and More Frequent Surgical Challenge. Clin Surg. 2018; 3: 1960.