Long-term Follow-up of Laparoscopic Repair of Parastomal Hernia Using a Bi-layer Mesh with a Slit

Introduction: Open surgery for parastomal hernia has been associated with high morbidity and high recurrence rates exceeding 40-50%, in particular after suture closure of the fascial defect or stomal re-siting. Laparoscopic mesh repair, however, has shown promising results, but published series have been relatively small with a short follow-up.
Methods and procedures: Since 1997 laparoscopic repair using a bi-layer mesh placed intraperitoneally has been performed in 72 consecutive patients with 48 colostomies and 24 ileostomies. The mesh, consisting of an outer layer of polypropylene and an inner non-adhering layer of extended PTFE towards the viscera, had a slit with a central keyhole modified after Hofstetter. After covering the fascial defect the slit was closed laterally. Data were prospectively recorded in a database (www.itsosimple.net). The median age of the patients was 62 years (range 34-84). 36 of the 72 patients had a history of previous stomal hernia repair, 19 of them had two or more previous repairs. Follow-up ranged from 9 months to 10 years (median 30 months).
Results: Adherences to anterior abdominal wall was observed 65 patients (90%). Adhesiolysis was time-consuming (median 60 min) and the apparent cause of inadvertent enterotomy in 8 of 10 patients with bowel injury. The median size of the parastomal fascial defect was 4×3 cm, the median size of the mesh 14×14 cm with a median overlap of 4 cm. Conversion to open surgery was necessary in three patients. Postoperative complications were: Bleeding (2), infection (3), stomal complications (4), seroma (7), and other complications (5) in a total of 16 patients (22%), nine of which required re-operation (13%). Two patients (3%) died postoperatively (missed bowel injury initially misinterpreted as myocardial infarction and bleeding in one patient with portal hypertension not recognized preoperatively). The median hospital stay was 3 days. Mesh-related complications were observed in six patients (8%): Infection occurred in four patients, requiring mesh removal in three patients, and in two patients the mesh was removed due to small bowel obstruction and stomal stenosis, respectively. Stomal hernia recurred in one patient one month after surgery (recurrence rate 1,4% – 95% confidence interval 0-7).
Conclusion: Laparoscopic mesh repair of parastomal hernia can be technically challenging. It is associated with a substantial postoperative morbidity including late mesh-related complications, but a recurrence rate of less than 7%.

Session: Podium Presentation

Program Number: S096

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