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Laparoscopic Repair of Parastomal Hernia Using a Porcine Dermal Collagen (Permacol(TM)) Implant.

Inan, Ihsan M.D.; Gervaz, Pascal M.D.; Hagen, Monica M.D.; Morel, Philippe
Diseases of the Colon & Rectum: September 2007
doi: 10.1007/s10350-007-0275-9
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Background: Surgical repair of parastomal hernias is usually performed through a laparotomy (stoma translocation) or a peristomal incision (mesh repair). Laparoscopic approach may minimize the risks of mesh infection and, thus, represents an attractive alternative. Permacol(TM) (Tissue Science Laboratories plc, Aldershot, Hampshire, U.K.) is a new biomaterial implant, which combines the strength and biocompatibility.

Technique: Case 1: A 67-year-old patient presented with paracolostomal hernia causing discomfort and intermittent obstructive episodes, 12 months after a proctectomy for severe radiation proctitis.

Case 2: A 74-year-old patient presented with a symptomatic paracolostomal hernia 18 years after abdominoperineal amputation.

Results: Both procedures took less than 120 minutes. Patients were started on a liquid and solid diet on postoperative Day 1 and discharged to home on the sixth and seventh postoperative days. There was no evidence of hernia recurrence or mesh-related complication at the time of last follow-up: nine months and three months postoperatively.

Conclusions: Compared with the traditional open technique, the technique described has two potential benefits: 1) the laparoscopic approach provides a means to avoid operating in a contaminated field and may reduce the risks of mesh infection; and 2) the use of a biologic graft may minimize the incidence of synthetic mesh-related complications, such as erosion into viscera and fistula. The use of biologic implants in this indication seems promising and deserves further evaluation.

(C) The ASCRS 2007