Suthep Udomsawaengsup, MD, Soravith Vijitpornkul, MD, Pakkavuth Chanswangphuvana, MD, Ajjana Techagumpuch, MD, Suppa-ut Pungpapong, MD, Chadin Tharavej, MD, Patpong Navicharern, MD. Chula Minimally Invasive Surgery Center, Chulalongkorn University.
Background
Parastomal hernia is common after stoma formation. Laparoscopic parastomal hernia repair provides an acceptable short-term result but incidence of seroma and recurrence is still high. Defect closure in ventral hernia repair has been reported to reduce seroma and may reduce recurrence. We have been applying defect closure in laparoscopic parastomal hernia repair. Our techniques and results of parastomal hernia were reviewed.
Methods
Patients underwent laparoscopic parastomal hernia repair between 2009 and 2013 were collected. Techniques, intraoperative and postoperative data, pain score and complications were analyzed.
Results
Twelve parastomal hernia repairs were performed in 10 patients. They were 7 rectal cancers (6 APR and 1 pelvic exenteration) and 3 uterine corpus cancers (2 pelvic exenteration and 1 hysterectomy with post radiation colitis required permanent colostomy). Median time to develop parastomal hernia was 1.5 years (0.2-10). There were 5 laparoscopic Sugarbaker repairs with defect closure, 5 laparoscopic Sugarbaker repairs, 1 laparoscopic keyhole repair and 1 laparoscopic-assisted-stomal-relocation. Mean operative time was 2.62 hours. Average pain score at 24 hour was 2.5(1-4). Three cases in laparoscopic Sugarbaker repairs without defect closure developed seroma, two of them required aspiration. Mean follow up was 8 months (1-42). One recurrence found 10 months after keyhole repair required laparoscopic sandwich technique and laparoscopic-assisted-stomal relocation performed 14 months later for another recurrence. There was no recurrence in laparoscopic Sugarbaker reapir.
Conclusions
Laparoscopic parastomal hernia repair with defect closure is feasible and safe. It reduces incidence of seroma. Long-term follow up needed to address recurrence.
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