Parastomal Hernia: A Modification of a Laparoscopic Technique

Background: Parastomal hernia is a common complication of stoma formation that has been reported in more than 50% of patients on long-term follow up. Multiple techniques have been described, but there is an absence of a consensus on the most advantageous method to repair parastomal hernia.
We propose a modification of a laparoscopic technique, which combines tissue repair, and mesh repair.

Methods: Since March 2005 we have started this new technique of laparoscopic repair of parastomal hernia.
Operative Technique:
After establishing pneumoperitoneum, three ports are located at the opposite side of the parastomal hernia. Four steps are important in this technique:
1- Reduction of hernia content and dissection of the hernia sac.
2- Suturing of the area around the stoma, including subcutaneous tissue, to the fascia.
3- Closure of the gap in the fascia with nonabsorbable stitches .
4- Reinforcement of the defect with a preformed hernia patch using tacks around the circumference of the mesh and transfascial stitches.

Result: From March 2005 to December 2006 three patients underwent laparoscopic repair of parastomal hernia using this technique. Two patients had a previous APR due to rectal cancer and the other patient had a proctocolectomy due to ulcerative colitis.
There were no conversions to open surgery and no intraoperative or postoperative complications. The follow up was 4, 7 and 11 months respectively and all patients are asymptomatic and without recurrence.

Conclusion: We describe a modified laparoscopic parastomal hernia repair technique. In addition to reducing and dissecting the hernia sac, we reduce the space by suturing the area around the stoma to the fascia, leading to a scar similar to the umbilicus with the purpose of reducing the incidence of seroma and decreasing the incidence of recurrence. We also repair stoma opening with stitches, reinforcing this tissue with a mesh.

Session: Poster

Program Number: P340

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