Parastomal Hernias - Clinical Study of Therapeutic Strategies

Parastomal hernias are parietal defects adjacent to the stomasite, after ileostomy and colostomy. Their incidence is variableand they are generally underestimated.Methods: Between 2001 and 2010 at the First Surgical ClinicIasi, we treated 861 incisional hernias, of which there were 31parastomal hernias in 26 patients (3%), 5 of which wererecurrent parastomal hernias. Parastomal hernias have beenexplored clinically, through imaging and intraoperatively.Because our experience and literature review havedemonstrated that a mesh repair is a safe procedure in thetreatment of parastomal hernia, in 2010 we initiated a prospectiverandomized trial on the use of prophylactic polypropylenemesh at the time of stoma formation to reduce the risk ofparastomal hernia. We enrolled in the study 20 patients withmesh implanted at the primary operation and 22 patientswithout mesh. The inclusion criteria were: patients with lowrectal cancer, stage II-III, irradiated, obese, with a history ofhernias, patients who do physical work.Results: Most parastomal hernias were asymptomatic; only sixcases with parastomal hernias required emergency surgicaltreatment. We performed local tissue repair in 16 cases (4 caseswith recurrent parastomal hernia, stoma relocation in onecase), sublay mesh repair in 15 cases (one case with recurrentparastomal hernia; stoma relocation in 5 cases). Postoperativemorbidity registered included 4 wound infections (one caseafter mesh repair which required surgical reintervention) andstoma necrosis in one case with strangulation parastomalhernia with severe postoperative evolution and death. Afterlocal tissue repair recurrences were seen in 6 cases, after meshrepair we registered recurrence only in one case and no relapseafter the relocation of the stoma. The patients with prophylacticmesh at the time of stoma formation to reduce the riskof parastomal hernia were followed for a median of 20 months(range 12 to 28 months) by clinical examination and ultrasoundexam every 3 months. We registered 6 recurrences(27,2%), all in the no mesh cohort. We have not seen anymorbidity in patients from the mesh group.Conclusions: Parastomal hernia is a relatively rare diseasecompared to the number of incisional hernias. With increasinglife expectancy stands we noted increased incidence ofparastomal hernia as well. Prophylactic use of mesh during theprimary operation is a safe procedure and reduces the risk ofparastomal hernia.

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