Institutional members access full text with Ovid®

The Use of Human Acellular Dermal Matrix for Parastomal Hernia Repair in Patients with Inflammatory Bowel Disease: A Novel Technique to Repair Fascial Defects.

Taner, Timucin M.D., Ph.D.1; Cima, Robert R. M.D., M.A.2; Larson, David W. M.D.2; Dozois, Eric J. M.D.2; Pemberton, John H. M.D.2; Wolff, Bruce G. M.D.2

Diseases of the Colon & Rectum: February 2009 - Volume 52 - Issue 2 - pp 349-354
doi: 10.1007/DCR.0b013e31819a3e69
Technical Notes

PURPOSE: Parastomal hernias occur frequently in patients with inflammatory bowel disease who require a stoma and are associated with high recurrence rates. The tissue weakness at the site of hernia can be overcome by creating neofascia using two separate layers of human acellular dermal matrix.

METHODS: Thirteen consecutive patients with inflammatory bowel disease with symptomatic parastomal hernia underwent open parastomal hernia repair at an academic tertiary referral center whereby the posterior and anterior rectus fascia at the stoma site was reconstructed with human acellular dermal matrix. Patients were followed prospectively for 290 ± 119 days (mean ± standard deviation), and data were reviewed for rate of postoperative complications, hernia recurrence, and patient satisfaction.

RESULTS: Mean operative time was 233 ± 80 (range, 129-355) minutes. No intraoperative complications occurred. Average hospital stay was 8.1 ± 2.4 (range, 6-14) days. Postoperative complications included seroma formation, incisional separation (2 patients each, 15.4 percent), and superficial wound infection (1 patient, 7.7 percent). There were two cases of asymptomatic hernia recurrence as determined by computerized tomography. These patients did not require any intervention. Overall patient satisfaction with the procedure was high.

CONCLUSIONS: In patients with parastomal hernia, reconstruction of the stoma site and abdominal wall with human acellular dermal matrix seems to be safe and results in high patient satisfaction.

1 Division of Gastrointestinal and General Surgery, Mayo Clinic, Rochester, Minnesota

2 Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 7 to 11, 2008.

Address of correspondence: Robert R. Cima, M.D., M.A., Mayo Clinic, Colon and Rectal Surgery, Gonda 9 South, Rochester, Minnesota 55905. E-mail: cima.robert@mayo.edu

© The ASCRS 2009