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Revisional laparoscopic parastomal hernia repair.

Zacharakis E, Shalhoub J, Selvapatt N, Darzi A, Ziprin P - JSLS (2008 Oct-Dec)

Bottom Line: On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac.Revisional laparoscopic repair of parastomal hernias seems feasible and has been shown to be safe and effective in this case.The success of this approach depends on longer follow-up reports and standardization of the technical elements.

View Article: PubMed Central - PubMed

Affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London United Kingdom. manoszacharakis@hotmail.com

ABSTRACT

Background: We herein report a laparoscopically performed re-do operation on a patient who had previously undergone a laparoscopic parastomal hernia repair.

Case report: We describe the case of a 71-year-old patient who presented within 3 months of her primary laparoscopic parastomal hernia repair with recurrence. On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac. This had allowed loops of small bowel to herniate into the sac. The initial part of the procedure involved the lysis of adhesions. A piece of Gore-Tex DualMesh with a central keyhole and a radial slit was cut so that it could provide at least 3 cm to 5 cm of overlap of the fascial defect. The tails of the mesh were wrapped around the bowel, and the mesh was secured to the margins of the hernia with circumferential metal tacking and 4 transfascial sutures. The patient remains in satisfactory condition and no recurrence or any surgery-related problem has been observed during 8 months of follow-up.

Conclusion: Revisional laparoscopic repair of parastomal hernias seems feasible and has been shown to be safe and effective in this case. The success of this approach depends on longer follow-up reports and standardization of the technical elements.

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Related in: MedlinePlus

Laparoscopic view of the recurrent fascial defect. The metal tacks of the primary laparoscopic repair are identified.
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Figure 1: Laparoscopic view of the recurrent fascial defect. The metal tacks of the primary laparoscopic repair are identified.

Mentions: On laparoscopy, despite the use of a Proceed mesh (Ethicon, UK) with its antiadhesive properties on the visceral surface, there were dense adhesions to the entire surface of the mesh, which had itself migrated into the hernia sac (Figure 1). No other adhesions were found in the abdominal cavity. The hernia defect was located at the lateral aspect of the stoma and measured 3 cm to 4 cm as in the primary repair. This had allowed loops of small bowel to herniate into the sac, hence recurrence. The initial part of the procedure involved the lysis of adhesions using sharp dissection techniques. The small bowel was reduced into the peritoneal cavity. No evidence was found of sepsis, either local or systemic, which would otherwise indicate mesh infection. As such, the original mesh was not retrieved from the hernia sac. Particular care was taken not to damage the mesentery of the colon and subsequently the blood supply to the stoma.


Revisional laparoscopic parastomal hernia repair.

Zacharakis E, Shalhoub J, Selvapatt N, Darzi A, Ziprin P - JSLS (2008 Oct-Dec)

Laparoscopic view of the recurrent fascial defect. The metal tacks of the primary laparoscopic repair are identified.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3015990&req=5

Figure 1: Laparoscopic view of the recurrent fascial defect. The metal tacks of the primary laparoscopic repair are identified.
Mentions: On laparoscopy, despite the use of a Proceed mesh (Ethicon, UK) with its antiadhesive properties on the visceral surface, there were dense adhesions to the entire surface of the mesh, which had itself migrated into the hernia sac (Figure 1). No other adhesions were found in the abdominal cavity. The hernia defect was located at the lateral aspect of the stoma and measured 3 cm to 4 cm as in the primary repair. This had allowed loops of small bowel to herniate into the sac, hence recurrence. The initial part of the procedure involved the lysis of adhesions using sharp dissection techniques. The small bowel was reduced into the peritoneal cavity. No evidence was found of sepsis, either local or systemic, which would otherwise indicate mesh infection. As such, the original mesh was not retrieved from the hernia sac. Particular care was taken not to damage the mesentery of the colon and subsequently the blood supply to the stoma.

Bottom Line: On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac.Revisional laparoscopic repair of parastomal hernias seems feasible and has been shown to be safe and effective in this case.The success of this approach depends on longer follow-up reports and standardization of the technical elements.

View Article: PubMed Central - PubMed

Affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London United Kingdom. manoszacharakis@hotmail.com

ABSTRACT

Background: We herein report a laparoscopically performed re-do operation on a patient who had previously undergone a laparoscopic parastomal hernia repair.

Case report: We describe the case of a 71-year-old patient who presented within 3 months of her primary laparoscopic parastomal hernia repair with recurrence. On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac. This had allowed loops of small bowel to herniate into the sac. The initial part of the procedure involved the lysis of adhesions. A piece of Gore-Tex DualMesh with a central keyhole and a radial slit was cut so that it could provide at least 3 cm to 5 cm of overlap of the fascial defect. The tails of the mesh were wrapped around the bowel, and the mesh was secured to the margins of the hernia with circumferential metal tacking and 4 transfascial sutures. The patient remains in satisfactory condition and no recurrence or any surgery-related problem has been observed during 8 months of follow-up.

Conclusion: Revisional laparoscopic repair of parastomal hernias seems feasible and has been shown to be safe and effective in this case. The success of this approach depends on longer follow-up reports and standardization of the technical elements.

Show MeSH
Related in: MedlinePlus