Wara P
Colorectal Division, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
Minerva Chir. 2011 Apr;66(2):123-8.
Repair of parastomal hernia remains controversial. Open suture repair of the fascial defect or stoma resiting are both associated with high morbidity and unacceptably high recurrence rates and are no longer recommended for routine use. Mesh repair appears to provide the best results. Following the first anectodal reports there are accumulating evidence that laparoscopic mesh repair is feasible and has a promising potential in the management of parastomal hernia. Two laparoscopic techniques have emerged, the use of a mesh with a slit and a central keyhole and a mesh without a slit, the latter often termed as a modified Sugarbaker. Published series, however, are observational and often with a short length of follow-up. Most series suffer from small sample size and controlled trials are lacking. The limited data, therefore, make it difficult to draw conclusions. At present none of the methods of open or laparoscopic mesh repair has proved superior. In spite of this laparoscopic repair has gained increasing acceptance. A polypropylene based mesh with an anti-adhesive layer covering the visceral side seems to be applicable using the keyhole technique with a slit as well as the modified Sugarbaker technique. A PTFE mesh should preferably be used with the modified Sugarbaker technique. If a PTFE mesh is used with the keyhole technique parastomal hernia is likely to recur.
造口旁疝的修复仍存在争议。开放性缝合修复筋膜缺损或重新安置造口均与高发病率及高得令人难以接受的复发率相关，不再推荐常规使用。补片修补似乎能取得最佳效果。在首批个案报道之后，越来越多的证据表明腹腔镜补片修补可行，在造口旁疝的治疗中具有广阔前景。出现了两种腹腔镜技术：使用带缝隙和中央钥匙孔的补片以及不带缝隙的补片，后者常被称为改良Sugarbaker法。然而，已发表的系列研究多为观察性研究，且随访时间往往较短。大多数系列研究样本量小，缺乏对照试验。因此，有限的数据难以得出结论。目前，开放性或腹腔镜补片修补方法均未证明具有优越性。尽管如此，腹腔镜修补已越来越被接受。一种基于聚丙烯且在内脏侧覆盖有抗粘连层的补片似乎适用于带缝隙的钥匙孔技术以及改良Sugarbaker技术。聚四氟乙烯补片最好与改良Sugarbaker技术一起使用。如果将聚四氟乙烯补片用于钥匙孔技术，造口旁疝很可能复发。
