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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.

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parastomal hernia repair

Parastomal Hernia Repair

C R Kapadia

Airedale General Hospital

parastomal hernia
Parastomal Hernia

“Some degree of herniation around a colostomy is so common that this complication may be regarded as inevitable”

Goligher

parastomal hernia1
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
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
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 hernia1
Incidence of Parastomal Hernia

50% Colostomy

[Nugent, 1999]

28% Ileostomy

[Williams, 1990]

5-8% Urostomy

[Rubin & Bailey1993]

diagnosis
Diagnosis

History

Examination - Standing - Lying

Valsalva manoeuvre

Digital examination of stoma

CT Scan

classification devlin
Classification (Devlin)

Interstitial

Subcutaneous

Intrastomal

Peristomal

risk factors
Risk Factors

Extrinsic

Emergency Surgery

Location of Stoma

Previous repair

Intrinsic

Age

Obesity

Wound Infection

Smoking

treatment
Treatment

Restore continuity of the intestine

indications for surgical repair
Indications for Surgical Repair

Strangulation

Obstruction

Fistula formation

Ischaemia

Pain

Body Image - patient expectation

choice of surgical procedures
Choice of Surgical Procedures

1. Stoma Relocation

2. Local Tissue Repair

3. Prosthetic Repair - intraperitoneal

- extraperitoneal

- fascial onlay

surgical repair
Surgical Repair

Increased infection rates

Recurrence 39% [Reiger, 2004]

Complications 57% [Hughes, 1999]

Laparoscopic repair with mesh 10% recurrence[Le Blanc, 2004]

cost effectiveness
Cost Effectiveness

Decreased:

Chest infection Wound infection Adhesion complications Earlier recovery Shorter patient stay Better productivity

advantages of laparoscopy
Advantages of Laparoscopy

Direct magnified vision allowingidentification of fine anatomy

Sharp precise dissection

Reduction of operating time

Reduced blood loss

choice of mesh
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

slide21

Pre op

Post op

slide22

Pre op

Post op

slide23

Pre op

Post op

slide24

Pre op

Post op

patients jan 2005
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
Follow Up

Patients reviewed 3 monthly

- 25 months

No mesh related bowel erosion, fistulisation or adhesion formation observed

2 recurrences - further repair

summary
Summary

Faster recovery of bowel function

Less morbidity

Shorter length of hospital stay

conclusion
Conclusion

Parastomal herniae are common

Associated with high morbidity

Laparoscopic repair decreases post-operative pain

Faster recovery

Decreased overall morbidity

Greater patient satisfaction