Berger Dieter, Bientzle Marc
Department of Surgery, Stadtklinik, Baden-Baden, Germany.
Dis Colon Rectum. 2007 Oct;50(10):1668-73. doi: 10.1007/s10350-007-9028-z.
The repair of parastomal hernias represents a surgical problem with high complication and failure rates. A basic principle is the necessity of mesh-based techniques. The study was performed to evaluate a laparoscopic approach, primarily based on the intraperitoneal on lay mesh technique.
Sixty-six patients with a symptomatic parastomal hernia were enrolled in the prospective study between November 1999 and February 2006. After complete adhesiolysis, the mesh was introduced to cover the fascial defect of the hernia and the original midline incision. In special cases, a two-mesh technique was used. First, an incised mesh was placed around the stoma sling. The second mesh was used to cover the abdominal wall with the first mesh; the stoma sling was placed between the two meshes for at least 5 cm.
The two-mesh technique proved to be superior in terms of recurrence rate especially in cases with a lateral fascial defect.
The laparoscopic repair of parastomal hernias is a surgically challenging procedure with promising results when using the two-mesh technique. Therefore, two meshes should be used in all cases of parastomal hernias. Polyvinylidene fluoride was revealed to be the most suitable material for the sandwich repair in terms of possible ingrowth and infection resistance.
造口旁疝的修复是一个手术难题，并发症和失败率都很高。基本原则是采用基于补片的技术。本研究旨在评估一种主要基于腹腔内置入补片技术的腹腔镜手术方法。
1999年11月至2006年2月期间，66例有症状的造口旁疝患者纳入了这项前瞻性研究。在完全松解粘连后，置入补片以覆盖疝的筋膜缺损和原中线切口。在特殊情况下，采用双补片技术。首先，将一片切开的补片围绕造口带放置。第二片补片用于覆盖腹壁及第一片补片；造口带置于两片补片之间至少5厘米。
双补片技术在复发率方面表现更优，尤其是在存在外侧筋膜缺损的病例中。
腹腔镜修复造口旁疝是一项具有手术挑战性的操作，采用双补片技术时效果良好。因此，所有造口旁疝病例均应使用两片补片。就可能的长入和抗感染能力而言，聚偏二氟乙烯被证明是三明治修复最合适的材料。
