You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Laparoscopic Parastomal Hernia Repair

Hiranyakas, Art M.D.; Ho, Yik-Hong M.D., B.S.(Hons.)

Section Editor(s): Hull, Tracy M.D., Editor

Diseases of the Colon & Rectum:
doi: 10.1007/DCR.0b013e3181e54048
Dynamic Article
Abstract

Parastomal hernia is a common complication after stoma formation. Its reported incidence varies from 30% to 50%. Loop ileostomy has the lowest risk (0%–6.2%), followed by end ileostomy, and loop colostomy with a similar risk of 28% to 30%. End colostomy carries the highest risk for parastomal hernia of 48%. Even though most hernias occur within the first 2 years after stoma construction, the risk of herniation extends up to 20 years. Theoretically, parastomal hernia occurs as a result of mechanical factors, an intrinsic defect in collagen metabolism, and wound repair. Parastomal hernia is asymptomatic most of the time, but it may be associated with serious complications such as strangulation and perforation; hence, elective repair is mandatory for carefully selected cases and surgical approaches. Primary closure of the aponeurosis at the hernia site, either via peristomal approach or through midline incision, is a simple procedure, but it carries a recurrence rate of 38% to 100%. Stoma relocation may result in a zero recurrence rate at the same hernia site, but the risk of a parastomal hernia after new stoma formation is still expected. In addition, an incisional hernia at the previous colostomy site closure may also occur. Similar to other sites of hernia repair, prosthetic mesh has been used to reinforce the hernia defect intraperitoneally through open incision and recently via the laparoscopic approach. Mesh repair has demonstrated the lowest risk of recurrence for parastomal hernia of 0% to 33%.

Author Information

Department of Surgery, James Cook University, Townsville, Queensland, Australia

Financial Disclosure: None reported.

Correspondence: Yik-Hong Ho, M.D., Department of Surgery, James Cook University, Townsville, Queensland, Australia. E-mail: yikhong.ho@jcu.edu.au.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dcrjournal.com).

© The ASCRS 2010