A Novel Method of Parastomal Hernia Repair
Introduction Parastomal hernia is a frequent complication after enterostomy formation. A repair using prosthetic mesh by way of a laparoscopic or open transabdominal approach is usually recommended, however, other procedures may be done if the repair is to be performed in a contaminated environment or when the abdominal cavity of the patient is difficult to enter due to postsurgical dense adhesion. The components separation method, which was introduced for non-transabdominal and non-prosthetic ventral hernia repair, solves such problems.
Case presentation Case 1. A 79-year-old Japanese woman who underwent total cystectomy with ileal conduit for bladder cancer presented with a parastomal hernia, which was repaired using a keyhole technique. Simultaneously, an incisional hernia in the midline was repaired with a prosthetic mesh. One year after her hernia surgery, a recurrence occurred lateral to the stoma, but it was believed to be difficult to enter the peritoneal cavity because of the wide placement of mesh. Therefore, surgery using the components separation method was performed.
Case 2. A 72-year-old Japanese man underwent an abdominoperineal resection for rectal cancer. At 5 and 12 months after his operation, a perineal hernia and an incisional hernia in the midline were repaired with prosthesis using a transabdominal approach, respectively. Three years after his rectal surgery, a parastomal hernia developed lateral to the stoma. For the same reason as case 1, surgery using the components separation method was performed. No recurrence was observed in either case as of 40 and 8 months after the last repair, respectively.
Conclusion The components separation method is a novel and effective technique for parastomal hernia repair, especially in cases following abdominal polysurgery or midline incisional hernia repairs using large pieces of mesh. To the best of our knowledge, this is the first report in English on the application of the components separation method for parastomal hernia repair.
Parastomal hernia is the most common stoma complication occurring in 1.8 to 28.3% of end ileostomy and 4.0 to 48.1% of end colostomy. Although classified as an abdominal incisional hernia, the parastomal hernia is quite different from other abdominal hernias because this type of hernia tends to be exposed to contaminated environments, and a part of the hernia orifice is made of the intestinal tract. Also, as midline incisional hernias frequently occur concomitantly with parastomal hernias, some patients already have incisional hernia repairs using large pieces of mesh, which makes it difficult to enter the peritoneal cavity for parastomal hernia repair if necessary. Local fascial repair for parastomal hernias results in recurrence and should be abandoned because of tension around the stoma. The components separation method (CSM), which has been suggested as a surgical technique that does not place stress on the atretic portion of the hernia orifice, does not need to enter the peritoneal cavity and can also be performed in contaminated environments. We report two cases of parastomal hernia successfully repaired with a modified CSM following incisional hernia repair with prosthesis.
Abstract and Introduction
Abstract
Introduction Parastomal hernia is a frequent complication after enterostomy formation. A repair using prosthetic mesh by way of a laparoscopic or open transabdominal approach is usually recommended, however, other procedures may be done if the repair is to be performed in a contaminated environment or when the abdominal cavity of the patient is difficult to enter due to postsurgical dense adhesion. The components separation method, which was introduced for non-transabdominal and non-prosthetic ventral hernia repair, solves such problems.
Case presentation Case 1. A 79-year-old Japanese woman who underwent total cystectomy with ileal conduit for bladder cancer presented with a parastomal hernia, which was repaired using a keyhole technique. Simultaneously, an incisional hernia in the midline was repaired with a prosthetic mesh. One year after her hernia surgery, a recurrence occurred lateral to the stoma, but it was believed to be difficult to enter the peritoneal cavity because of the wide placement of mesh. Therefore, surgery using the components separation method was performed.
Case 2. A 72-year-old Japanese man underwent an abdominoperineal resection for rectal cancer. At 5 and 12 months after his operation, a perineal hernia and an incisional hernia in the midline were repaired with prosthesis using a transabdominal approach, respectively. Three years after his rectal surgery, a parastomal hernia developed lateral to the stoma. For the same reason as case 1, surgery using the components separation method was performed. No recurrence was observed in either case as of 40 and 8 months after the last repair, respectively.
Conclusion The components separation method is a novel and effective technique for parastomal hernia repair, especially in cases following abdominal polysurgery or midline incisional hernia repairs using large pieces of mesh. To the best of our knowledge, this is the first report in English on the application of the components separation method for parastomal hernia repair.
Introduction
Parastomal hernia is the most common stoma complication occurring in 1.8 to 28.3% of end ileostomy and 4.0 to 48.1% of end colostomy. Although classified as an abdominal incisional hernia, the parastomal hernia is quite different from other abdominal hernias because this type of hernia tends to be exposed to contaminated environments, and a part of the hernia orifice is made of the intestinal tract. Also, as midline incisional hernias frequently occur concomitantly with parastomal hernias, some patients already have incisional hernia repairs using large pieces of mesh, which makes it difficult to enter the peritoneal cavity for parastomal hernia repair if necessary. Local fascial repair for parastomal hernias results in recurrence and should be abandoned because of tension around the stoma. The components separation method (CSM), which has been suggested as a surgical technique that does not place stress on the atretic portion of the hernia orifice, does not need to enter the peritoneal cavity and can also be performed in contaminated environments. We report two cases of parastomal hernia successfully repaired with a modified CSM following incisional hernia repair with prosthesis.
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