Köhler Gernot, Mayer Franz, Wundsam Helwig, Schrittwieser Rudolf, Emmanuel Klaus, Lechner Michael
Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.
Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria.
World J Surg. 2015 Nov;39(11):2795-804. doi: 10.1007/s00268-015-3187-1.
Over the years, various open and laparoscopic approaches toward the repair of parastomal hernias (PSH) have been described. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures.
From January 1999 to January 2014, we assessed all cases of PSH repair performed at the three participating surgical departments in a retrospective analysis. The results were evaluated with regard to different surgical techniques focusing on complications and recurrences.
One hundred and thirty-five individuals could be included in the analysis. They were operated on with eight different surgical techniques. Laparoscopic procedures were carried out in 46.7 % (63/135) of the cases. Median follow-up was 54 months (12-146 months). We found 44 cases of recurrence (32.6 %) and 24 (17.8 %) of the patients experienced perioperative complications and 12 of them needed to return to theater. Fourteen of the 135 patients (10.4 %) were operated as emergency cases which were associated with a mortality of 28.6 % (4/14). In case of elective PSH repair, no mortality occured.
The results achieved by direct suture or the use of incised flat meshes for the repair of PSH were poor with these procedures having unacceptably high recurrence rates. With regard to the latter ostomy revision through three-dimensional funnel-shaped meshes and the laparoscopic sandwich technique showed the best results. Emergency procedures were linked to a dramatic increase in morbidity and mortality (p < 0.001).
多年来，已经描述了各种开放和腹腔镜治疗造口旁疝（PSH）的方法。已发表技术的多样性本身可被视为手术程序满意度往往较低的一个指标。
1999年1月至2014年1月，我们对三个参与手术科室进行的所有PSH修复病例进行了回顾性分析。针对不同手术技术，重点评估并发症和复发情况来评价结果。
135例患者纳入分析。他们接受了8种不同的手术技术治疗。46.7%（63/135）的病例采用了腹腔镜手术。中位随访时间为54个月（12 - 146个月）。我们发现44例复发（32.6%），24例（17.8%）患者出现围手术期并发症，其中12例需要返回手术室。135例患者中有14例（10.4%）作为急诊病例进行手术，其死亡率为28.6%（4/14）。择期PSH修复病例无死亡发生。
直接缝合或使用切开的平片修补PSH的效果较差，这些手术的复发率高得令人无法接受。对于后者，通过三维漏斗形补片进行造口修复和腹腔镜三明治技术显示出最佳效果。急诊手术与发病率和死亡率的显著增加相关（p < 0.001）。
