Lateral repair of parastomal hernia

Introduction: Parastomal hernia is a common complication of stoma construct ion. Although the majority of patients are asymptomatic, about 10% require surgical correction. Aims: We describe a new surgical approach for the repa ir of parastomal hernias, which avoids both the need for laparotomy and sto ma mobilization. Patients and Methods: Nine patients (4 female) with parastomal hernia under went surgical repair. Median age was 55 years (range 38-73 years). There we re 8 para-ileostomy herniae and one paracolostomy hernia. A lateral incisio n was made approximately 10 cm from the stoma, and carried down to the rect us sheath. The dissection was carried medially towards the stoma, and aroun d the defect in the abdominal musculature. The hernia sac was excised when possible and the fascial defect closed with non-absorbable, monofilament su ture. A polyprolene mesh was placed round the stoma by making a slit in the mesh. The skin was closed with subcuticular monofilament absorbable suture . Results: All patients returned to normal diet on the first postoperative da y, and were discharged from hospital within 72 h. There were no wound infec tions, and no recurrences after a median follow up of 6 months (range 3-12 months). Discussion: The technique we describe is simple and avoids the need of lapa rotomy. The mucocutaneous junction of the stoma is not disturbed, reducing the risk of contamination of the mesh, stenosis or retraction of the stoma. Grooving of the stoma and difficulty in fitting appliances is avoided beca use the wound is not placed near the mucocutaneous junction. This approach may be superior to other mesh repairs for parastomal hernia.