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Parastomal Hernia Repair: C R Kapadia Airedale General Hospital

This document discusses parastomal hernias, which occur around abdominal wall stomas. It notes that parastomal hernias are common, occurring in 20-50% of patients depending on the type of stoma. The document reviews risk factors, types, diagnosis, and treatment options for parastomal hernias. It finds that laparoscopic surgical repair of parastomal hernias using mesh results in faster recovery, less morbidity, and shorter hospital stays compared to open surgical techniques.

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Kana Fajar
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54 views29 pages

Parastomal Hernia Repair: C R Kapadia Airedale General Hospital

This document discusses parastomal hernias, which occur around abdominal wall stomas. It notes that parastomal hernias are common, occurring in 20-50% of patients depending on the type of stoma. The document reviews risk factors, types, diagnosis, and treatment options for parastomal hernias. It finds that laparoscopic surgical repair of parastomal hernias using mesh results in faster recovery, less morbidity, and shorter hospital stays compared to open surgical techniques.

Uploaded by

Kana Fajar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Parastomal Hernia Repair

C R Kapadia
Airedale General Hospital
Parastomal Hernia

“Some degree of herniation around


a colostomy is so common that
this complication may be
regarded as inevitable”

Goligher
Parastomal Hernia

An Incisional Hernia related


to an abdominal wall stoma.
Particularly noticeable on
tensing the abdominal wall
muscles- coughing, sneezing,
straining or standing.
Para Stomal Hernia

Parastomal herniation is not


uncommon and the management
of a parastomal hernia is a
common clinical dilemma.

Once such a hernia is established,


it is difficult to treat, and many
operative factors have been
claimed to influence its
occurrence and many techniques
of repair have been described.

[Carne, Robertson and Frizelle]


Incidence of Parastomal Hernia

0 – 48% depending on type of stoma


and length of follow up
[Carne, PWG; Robertson, GM; Frizelle, FA. 2003]

20-25% Commoner in end colostomy


[Devlin, 1982]

67% transverse loop colostomy


[Nordstrum &Hulten, 1987]
Incidence of Parastomal Hernia

50% Colostomy
[Nugent, 1999]

28% Ileostomy
[Williams, 1990]

5-8% Urostomy
[Rubin & Bailey1993]
Diagnosis

History
Examination - Standing
- Lying
Valsalva manoeuvre
Digital examination of stoma
CT Scan
Classification (Devlin)

Interstitial
Subcutaneous
Intrastomal
Peristomal
Risk Factors

Intrinsic Extrinsic
Age Emergency Surgery
Obesity Location of Stoma
Wound Infection Previous repair
Smoking
Treatment

Restore continuity of the intestine


Indications for Surgical Repair

Strangulation
Obstruction
Fistula formation
Ischaemia
Pain
Body Image - patient expectation
Choice of Surgical Procedures

1. Stoma Relocation

2. Local Tissue Repair

3. Prosthetic Repair - intraperitoneal


- extraperitoneal
- fascial onlay
Surgical Repair

Increased infection rates

Recurrence 39% [Reiger, 2004]

Complications 57% [Hughes, 1999]

Laparoscopic repair with mesh


10% recurrence [Le Blanc, 2004]
Laparoscopic Surgery
Cost Effectiveness

Decreased:
Chest infection
Wound infection
Adhesion complications
Earlier recovery
Shorter patient stay
Better productivity
Advantages of Laparoscopy
Direct magnified vision allowing
identification of fine anatomy

Sharp precise dissection

Reduction of operating time

Reduced blood loss


Choice of Mesh

1. Compound polypropylene

2. e PTFE expanded
polytetrafluoroethylene

3. Mixtures of absorbable and


permanent fibres woven
together to minimise the
foreign body reaction
Choice of Mesh
Pre op Post op
Pre op Post op
Pre op Post op
Pre op Post op
Patients Jan 2005

Female 76 years Colostomy 3 days


Female 52 years Colostomy 5 days
Male 68 years Colostomy 4 days
Female 73 years Colostomy 4 days
Female 68 years Urostomy 5 days
Female 78 years Colostomy 6 days
Female 68 years Ileostomy 4 days
Male 58 years Ileostomy 5 days
Male 49 years Ileostomy 4 days
Female 65 years Colostomy 4 days
Follow Up

Patients reviewed 3 monthly

- 25 months

No mesh related bowel erosion, fistulisation


or adhesion formation observed

2 recurrences - further repair


Summary

Faster recovery of bowel function

Less morbidity

Shorter length of hospital stay


Conclusion

Parastomal herniae are common


Associated with high morbidity
Laparoscopic repair decreases
post-operative pain
Faster recovery
Decreased overall morbidity
Greater patient satisfaction

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