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™ (Tissue Science Laboratories plc, Aldershot, Hampshire, U.K.) is a new biomaterial implant, which combines the strength and biocompatibility.
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.
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.
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.
1Department of Surgery, University Hospital Geneva, Geneva, Switzerland
2Service de Chirurgie Viscérale, Hôpital Universitaire de Genève, 24 Rue Micheli-du-Crest, 1211, Genève, Switzerland
The online version of this article (DOI: 10.1007/s10350-007-0275-9) contains supplementary material which is available to authorized users. This multimedia article (video) has been published online and is available for viewing at http://springerlink.com. As a subscriber to Diseases of the Colon & Rectum, you have access to our SpringerLink electronic service, including Online First.
Presented at the meeting of the Swiss Surgical Society, Lugano, Switzerland, June 21 to 23, 2006, and the meeting of the International Colorectal Disease Symposium, Fort Lauderdale, Florida, February 15 to 17, 2007.
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