RECURENT PARASTOMAL HERNIA AND MIDDLE INCISIONAL HERNIA: SURGICAL TREATMENT THROUGH MIDLINE INCISION WITH WIDE PRO STHETIC MESH

Abstract

Parastomal hernia is a frequent complication of stoma surgery. The results of parastomal hernia repair however are poor, showing an high incidence of postoperative recurrences. In the last years, hernia repair with prosthetic mesh has given better postoperative results. The parastomal hernia , however, is associated with middle incisional hernia. The authors review the problem of surgical repair of parastomal hernia and report a case of recurrent parastomal hernia associated to middle incisional hernia. The technique of surgical repair using, through midline incision, one, wide, prosthetic polypropylene mesh, in sublay position, according to Rives’ technique, is described. The mesh has been incised in a trasverse direction for the stoma crossing. At 6 years followup the patient does not show postoperative recurrence. According leterature and the authors’ results, the parastomal hernia might be considered an incisional hernia and, therefore, a sing of diffuse abdominal wall disease. The Rives’ surgical technique might be the gold standard for treatment of parastomal hernia, even if not associated to incisional hernia. The more complexity of Rives’ technique compared to local fascial mesh repair is compensated by the result of total abdominal wall reinforcement.