Laparoscopic Repair of Parastomal Hernias: a Multi-Centre Retrospective review and Shift in Technique

Abstract

Purpose: To describe the reasons for a shift in our technique of laparoscopic repair of parastomal hernias towards repair with a non-slit mesh. Our initial results with repair using meshes with a keyhole had high recurrence rates. Methods: We performed a multi-centre retrospective study focusing on complications and recurrences. Data were gathered retrospectively from the medical records. The last follow-up date was the latest clinical examination by the surgeon. Recurrences were diagnosed clinically or by CT scan performed for oncological follow-up in cancer patients. Results: From September 2001 till May 2007, twenty-four patients with a symptomatic parastomal hernia were treated laparoscopically. No major intra-or postoperative complications were encountered. We had no conversions, no enterotomies and the overall postoperative morbidity was 8.4% (2/24). During a mean follow-up of 21.2 months, ten recurrences or 41.7% (10/24) have been diagnosed. In patients treated with a “keyhole technique” recurrence rate was 72.7% (8/11) with a mean follow-up of 30.7 months. In patients treated with a “modified Sugarbaker technique” recurrence rate was 15.4% (2/13) with a mean follow-up of 14.0 months.

Conclusions: We found laparoscopic parastomal hernia repair could be performed with few complications. We abandoned the “keyhole techniques” because of a high recurrence rate. We currently use a “modified Sugarbaker technique” with promising early results.

Key Words:

• Laparoscopy
• parastomal hernia
• abdominal wall hernia
• mesh
• hernioplasty
• colostomy

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F.E. Muysoms

Dr. F. Muysoms Az Maria Middelares Kortrijksesteenweg 1026 9000 Gent, Belgium Tel.: [phone] Fax: [phone] E-mail: [email protected]