C Palanivelu, MCH FACS FRCS, P Senthilnathan, MS DNB, P S Rajan, MS FACS, S Rajapandian, MS DNB, R Parthasarathi, MS, P Praveenraj, MS. GEM Hospital
Paracolostomy hernia is one of the common complications of a permanent colostomy. Various surgical procedures have been described for this condition. We present a video of laparoscopic repair of paracolostomy hernia using intra peritoneal onlay mesh. Patient is placed in supine position with all the ports are placed well away from the ostomy site. Totally three ports are placed- one 10mm port in the right anterior axillary line at the level of umbilicus for camera and 2 working trocars at right lumbar and suprapubic region. Surgeon and camera surgeon stand on right side of the patient. Procedure starts with the adhesiolysis surrounding the ostomy site. Once the ostomy site is reached, the contents of the hernia are reduced. The colon is pulled down and the surrounding defect is closed with 1 loop ethiton using intracorporeal continuous sutures which is fixed transfacially. A composite mesh(Gortex) is then placed intraperitonially surrounding the defect with the stoma being pushed against the parietal wall and covered by mesh. Mesh is fixed with both tranfacial and intracorporeal sutures. We operated 7 cases. The mean operating time 108 minutes (range 82-135). Patients were discharged in 2-3 days. There has been no recurrence after 8-25 months followup. Conclusion: Laparoscopic intraperitoneal onlay mesh placement is ideal for paracolostomy hernia and with sutured reinforcement of the defect, it provides excellent support to the surrounding fascia. It also avoids one more laparotomy which will reduce the tensile strength further.
Program Number: V079