Laparoscopic Parastomal Hernia Repair and Re-ostomy,a Totally New Lap-re-do Technique

Yao Qiyuan. Huashan Hospital, Shanghai Medical Collage, Fudan University,

Background: Paracolostomal hernia is a common postoperative complication of colostomies. Laparoscopic paracolostomal hernia repairs have been reported for at least five techniques so far with variable and unsatisfactory follow-up results, especially for the high incident rate of postoperative recurrence. Herein we developed and applied a totally new Lap-re-Do technique to laparoscopic paracolostomal hernia repair to reduce the postoperative complications, with the quietly different idea from current laparoscopic procedures.
Methods: We applied the Lap-re-Do technique to laparoscopic paracolostomal hernia repairs on 26 patients with PVDF mesh from May 2009 to June 2011, including 2 single-incision laparoscopic surgical (SILS) procedures. The demographic, perioperative, and early follow-up data prospectively collected for these patients are presented in this report.
Results: All the 26 operations were performed successfully, including 19 patients under routine laparoscopic procedures (median operative time, 100.5 min), 4 patients detected with incisional hernia being repaired simultaneously (median operative time, 132.5 min), 1 patient with recurrent paracolostomal hernia (operative time, 160 min) and 2 patients under SILS procedures (median operative time, 122.5 min). No in-hospital mortality occurred. Postoperative recovery was uneventful for all the 21 patients (80.8%), who had a median hospital stay of 6.1 days. Surgical and nonsurgical complications occurred, respectively, for one patient with mild stoma collapse (3.8%), one patient with arrhythmia (3.8%), one patient with mild seroma (3.8%), one patient with accidental enterotomy detected and re-operated in 2 days after the primary operation without removal of PVDF mesh (3.8%), and two patients with postoperative ileus and recovery of conservative treatments (7.7%). In 8 weeks after discharge from hospital, all the patients were reexamined by physical examination and computerized tomography scan, and the follow-up results (median follow-up time, 12.5 months) indicated no recurrence, no severe seroma, no intractable pain, none complications of mesh-related infection and no dysfunction of defecation.
Conclusions: Laparoscopic paracolostomal hernia repair with Lap-re-Do technique is effective and feasible.
 

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