Laparoscopic treatment of parastomal hernia using Sugarbaker technique with Parietex composite mesh

Madoka Hamada, MD, Taishi Tamura, MD, Shuichi Sakamoto, MD, Yuki Katsura, MD, Toshiaki Toshima, MD, Takuya Kato, MD, Michinori Hamaoka, MD, Soichiro Miyake, MD, Hisanobu Miyoshi, MD, Yasuhiro Fujiwara, MD, Yasuhiro Chouda, MD, Takashi Kanazawa, MD, Masao Harano, MD, Hiroyoshi Matsukawa, MD, Yasutomo Ojima, MD, Shigehiro Siozaki, MD, Satoshi Ohno, MD, Masazumi Okajima, MD, Motoki Ninomiya, MD

Hiroshima City Hospital

Background Parietex™ Composite (PCO) Parastomal mesh (Covidien Hampshire Street. Mansfield, USA) is a monofilament mesh providing a custom design for parastomal hernia repair, which offer a resorbable collagen barrier on one side to limit visceral attachments. We report our experience using Sugarbaker type PCO parastomal mesh laparoscopically for the treatment of the parastomal hernia (PH) of the endsigmoid colostomy.

Patients of the Methods From March 2005 to December 2010 consecutive 37 patients underwent laparoscopic abdominoperineal resection (APR) and were followed in the outpatient setting in Kochi Health Sciences Center. Six Cases of them developed PH and all but one cases had a stoma that was created through the trans-abdominal route. Four cases whose stoma were created through the trans-abdominal route were treated with Sugerbaker type PCO using laparoscopic technique.

Technique A transverse incision (length 3 cm) was added in the rt. upper quadrant, which was protected with an ALEXIS WOUND RETRACTOR SYSTEM (small size; Applied Medical Co., Rancho Santa Margarita, CA). Two 10mm trocars were introduced through the incised fingertips of the 8-0 size elastic glove covering the ALEXIS. Another one trocar (5mm) was introduced in the rt. lower quadrant. All but one cases did not require adhesiolysis, but all cases required division of the lt. colic artery that was preserved in the initial surgery to achieve adequate lateralisation of the colon. We measured the hernia defect on the anterior abdominal wall and select the size of the PCO ( three cases were 15cm in diameter and another one was 20cm). Orientation marking was made on the colagen film site, and four interrupted sutures were placed at the medial side of the mesh for the transfascial fixation. PCO was introduced into the abdominal cavity through the finger tip of the grove avoiding damage of the colagen film of the mesh after immersed in a water . Using Endoclose™ (Covidien Hampshire Street. Mansfield, USA), transfascial fixation at the medial side of the mesh was performed. Further fixation was performed using spiral tackers (Absorbatack™, Covidien Hampshire Street. Mansfield, USA) as a fixation device taking care to adjust the colon loop along the center band of the mesh.

Results Male to female ratio was 3:1, and mean age was 64.8 yeas. Duration from the APR to the hernia operation was 15.3 (6-22) months. Mean operation time was123 (88-195) min. Mean blood loss was under 10ml. Mean hospital stay was 10 (5-22) days. There was no mortality. One case experienced paralytic ileus that was relieved by conservative treatment. Mean follow up period was 11.5 (10-13)months. There was no recurrence of the PH after this operation.

Conclusion As Sugarbaker’s technique might provide the same effect as the retroperitoneal route, this technique using PCO mesh can be a promising procedure for the treatment of the PH of the endsigmoid colostomy.

Session: Poster Presentation

Program Number: P302

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