Use of biologic mesh for a complicated paracolostomy hernia

Abstract Background Parastomal hernias are among the most frustrating and incapacitating complications of permanent colostomies. Because the traditional surgical options of primary repair with or without ostomy repositioning have led to disappointing results, the use of mesh is indicated, especially...

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Bibliographic Details
Published in:The American journal of surgery 2008-11, Vol.196 (5), p.715-719
Main Authors: Lo Menzo, Emanuele, M.D., Ph.D, Martinez, Jose M., M.D, Spector, Seth A., M.D, Iglesias, Alberto, M.D, DeGennaro, Vincent, M.D, Cappellani, Alessandro, M.D
Format: Article
Language:English
Subjects:
Abdomen
Aged
Animals
Biologic mesh
Biological and medical sciences
Cattle
Collagen
Colostomy - adverse effects
Defects
General aspects
Hernia, Ventral - etiology
Hernia, Ventral - surgery
Hernias
Humans
Infections
Male
Malnutrition
Medical sciences
Mesh
Obesity
Ostomy
Pain
Paracolostomy hernia
Pericardium - transplantation
Polytetrafluoroethylene
Radiation therapy
Recurrence
Relocation
Self image
Skin
Strangulation
Surgery
Surgical Mesh
Treatment Outcome
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Summary:Abstract Background Parastomal hernias are among the most frustrating and incapacitating complications of permanent colostomies. Because the traditional surgical options of primary repair with or without ostomy repositioning have led to disappointing results, the use of mesh is indicated, especially in the setting of multiple recurrences. Methods After laparoscopic lyses of adhesions, the colostomy is pushed against the lateral abdominal wall, and a bovine pericardium graft is gently stretched and draped over the colostomy (the Sugarbaker technique). Transfascial sutures and tacks are placed along the perimeter of the mesh and around the colon to prevent small bowel herniation. Results The patient developed a small seroma postoperatively, which resolved spontaneously. At his 17-month follow-up, the patient had no evidence of recurrence, he was pain free, and he was satisfied with his cosmetic results. Conclusion Although several studies indicate the feasibility and efficacy of synthetic permanent mesh repair, the concerns of mesh infection, erosion, and ostomy obstruction still persist. The authors suggest parietalizing the bowel and using a biologic mesh.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2008.07.012