Surgical treatment of parastomal hernia complicating sigmoid colostomies
Surgical treatment of parastomal hernia complicating sigmoid colostomies
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DOI：
10.1007/bf02234303
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发表时间：
2001-02-01
影响因子：
3.9
通讯作者：
Chiu, WY
中科院分区：
文献类型：
--
作者：
Cheung, MT;Chia, NH;Chiu, WY
目的：吻合口旁疝气是结肠造口术后常见的晚期并发症。吻合口旁疝修补术的手术方法是有争议的。手术治疗的结果令人失望。这项研究的目的是评估手术治疗吻合口旁疝气的结果。方法：回顾分析乙状结肠造口术后吻合口旁疝患者的临床资料。仔细研究了这些手术的适应证、手术方法、并发症和结果。结果：共手术治疗吻合口旁疝43例。16例行单纯局部修补，25例行造口移位，2例行网片局部修补。总的复发率为18/10(45%)。筋膜修补术和吻合口移位术的复发率分别为6/13(46%)和10/25(40%)。25例中19例无需剖腹手术即可完成吻合口移位。在这25个移位中，只有2个发生了切口疝气。结论：单纯筋膜修补术治疗有症状的小腹股沟疝气具有并发症少的优点。对于较大的腹股沟疝气，可以提倡不经正式剖腹而行造口移位术。局部加固与网状加固相结合可能是进一步改善效果的替代方案。
PURPOSE: Parastomal hernia is a common late complication of colostomy. Surgical approach to the repair of parastomal hernia is controversial. Results of surgical treatment are disappointing. The aim of this study was to assess the outcome of surgical treatment of parastomal hernia. METHOD: This article reports a retrospective review of those patients who had undergone a surgical treatment of parastomal hernia complicating sigmoid colostomy. The indications, surgical procedures, complications, and outcome were carefully studied. RESULTS: There were 43 surgical treatments of parastomal hernia. Sixteen underwent simple local repair; 25 stomas were relocated, and 2 were locally repaired with mesh. Overall recurrence was 18 of 10 (45 percent). Recurrences for fascial repair and stoma relocation were 6 of 13 (46 percent) and 10 of 25 (40 percent), respectively. Stoma relocation could be accomplished without formal laparotomy in 19 of 25 cases. Incisional hernia occurred in only 2 of these 25 relocations. CONCLUSION: Fascial repair alone can be performed for symptomatic small hernias because of its advantage of minimal morbidity. Stoma relocation without formal laparotomy can be advocated for larger hernias. A combination of local resite together with mesh reinforcement may be the alternative for further improvement of results.