OF POLYPROPYLENE MESH

P. NAJAFGULIEVA

Azerbaijan Medical University, Baku, AZERBAIJAN

A parastomal hernia is a type of incisional hernia that occurs at the site of the stoma or immediately adjacent to the stoma. It forms when the abdominal wall defect, the trephine, is continually stretched by the tangential forces applied along the circumference of the abdominal wall opening. A PSH is the most frequent complication following the construction of a colostomy or an ileostomy. A literature review found that PSH occurs in 1.8 to 28.3 percent of patients with end ileostomies, 0 to 6.2 percent with loop ileostomies, 4.0 to 48.1 percent with end colostomies, and 0 to 30.8 percent with loop colostomies. 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.

Materials and methods: Between 2002 to 2010 in Scientific Surgery Center named after M.A.Topchubashov, were treated 142 incisional hernias, of which there were 27 parastomal hernias at 21 patients, 6 of which are recurrent parastomal hernia. Clinical examination, intraoperative exploration and CT exam stated the following subtypes of parastomal hernia: interstitial (sac within layers of the abdominal wall) - 9 cases; subcutaneous (hernia sac in the subcutaneous plane) - 10 cases; intrastomal (sac penetrates into stomy) - 5 cases; peristomal (sac is within prolapsing stoma) – 3 cases. The most parastomal hernias were asymptomatic; only six cases with parastomal hernias required emergency surgical treatment for obstruction (3 cases) or strangulation (3 cases). Two patients had associated median incisional hernia. We performed: local tissue repair in 11 cases (3 cases with recurrent parastomal hernia; stoma relocation in one case); sublay polypropylene mesh repair in 16 cases (3 cases with recurrent parastomal hernia; stoma relocation in 2 cases). Associated surgery were practiced: viscerolysis, colic resection (3 cases), small bowel resection (1 cases). All patients resumed a normal diet 1 day after surgery; the median hospital stay was 5 (3-14) days. Postoperative morbidity registered were 3 wound infections (one case after mesh repair which required surgical reintervention) and stoma necrosis in one case with strangulation parastomal hernia. After local tissue repair recurrences were seen in 4 cases, after mesh repair we registered recurrence only in one case, that helped a parietal suppuration and no relapse after the relocation of the stoma.

Result: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 polypropylene mesh reinforcement may be the alternative for further improvement of results.

Date: 2014-12-28; view: 1001