Laparoscopic parastomal hernia repair.
Laparoscopic parastomal hernia repair.
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DOI：
10.1007/s10029-004-0295-5
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发表时间：
2005-05-01
期刊：
影响因子：
--
通讯作者：
Hausmann, M G
中科院分区：
文献类型：
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作者：
LeBlanc, K A;Bellanger, D E;Hausmann, M G
造口旁疝修补术对疝外科医生来说是一项重大挑战。这些疝的修复是指由于不合适的器具，美容畸形，无法保持适当的卫生和疝本身的并发症，如嵌顿或绞窄。最近的文献报道表明，46%的患者可进行一期筋膜修复，而造口的重新定位与40%的复发率相关。因此，本次修复采用了聚丙烯网片。这种开放技术的复发率仍将导致20- 29%的失败率。此外，该生物材料还存在其他并发症，如阻塞、瘘管形成或补片侵蚀。腹腔镜手术为这一难题提供了一种新的选择。我们使用ePTFE以三种不同的方法修复了12例造口旁疝。有八个结肠造口术，两个回肠造口术和两个尿道造口术疝。随访3-39个月，平均20个月。有1例复发需要2次修复（8%）。其他并发症包括肠切开术（1例患者）、肠梗阻（1例）、血清肿（1例）和术后误吸死亡（1例）。腹腔镜下修补造口旁疝似乎是一个有前途的技术，这一复杂的困境。
Repair of parastomal represents a significant challenge for the hernia surgeon. Repair of these hernias is indicated because of an ill-fitting appliance, cosmetic deformity, inability to maintain proper hygiene and complications from the hernia itself such as incarceration or strangulation. Recent reports in the literature have shown that primary fascial repair can occur in 46% of patients and relocation of the stoma is associated with a 40% recurrence rate. For this reason, the use of polypropylene mesh has been applied to this repair. The recurrence rate with this open technique will still incur a failure rate of 20-29%. Additionally there are other complications such as obstruction, fistulization or mesh erosion with this biomaterial. The laparoscopic approach to this hernia may offer a new choice for this difficult problem. We have used ePTFE to repair 12 parastomal hernias with three different approaches. There have been eight colostomy, two ileostomy and two urostomy hernias. Follow-up ranges from 3-39 months (average 20 months). There has been one recurrence that required two repairs (8%). Other complications included enterotomy (one patient), ileus (one), seroma (one), and death from postoperative aspiration (one). The laparoscopic repair of parastomal hernias appears to be a promising technique for this complex dilemma.