Department of General and Visceral Surgery, Congregation Hospital Sisters of Charity, 4010, Linz, Austria.
Department of Surgery, St John of God Hospital, Marschallgasse 12, 8020, Graz, Austria.
World J Surg. 2017 Dec;41(12):3212-3217. doi: 10.1007/s00268-017-4130-4.
Parastomal hernias (PSHs) are a common and challenging issue. In previous studies, three-dimensional (3D) funnel mesh devices have been used successfully for the repair of PSHs.
We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmentation in intraperitoneal (IPOM) position at our department between the years of 2012 and 2015. Primary outcome parameters were intra- and postoperative surgical complications and recurrence rate during the follow-up period.
Fifty-six patients could be included in this analysis. PSH repair was performed in 89.3% as elective surgery and in 73% in laparoscopic technique. A concomitant incisional hernia (EHS type 2 and 4) was found in 50% and repaired in a single-step procedure with PSH. Major postoperative complications requiring redo surgery (Clavien-Dindo ≥3b) were identified in 8.9% (5/56). Overall recurrence rate was 12.5% (7/56). Median follow-up time was 38 months, and a 1-year follow-up rate of 96.4% was reached.
PSH repair with 3D funnel mesh in IPOM technique is safe, efficient and easy to perform in laparoscopic and open surgical approaches providing advantageous results compared to other techniques. Furthermore, simultaneous detection and treatment of concomitant incisional hernias has shown favorable. However, the mesh funnel distends and becomes shortened encasing a bulky bowel mesentery and further shrinkage happens eccentric. Changing mesh construction according to lengthening the funnel could possibly lead to reduction in recurrence.
造口旁疝（PSH）是一种常见且具有挑战性的问题。在之前的研究中，三维（3D）漏斗形网状装置已成功用于 PSH 的修复。
我们对 2012 年至 2015 年在我科接受同侧造口重新定位并在腹腔内（IPOM）位置使用 3D 漏斗形网状增强术的患者前瞻性收集的数据进行了分析。主要观察指标为围手术期手术并发症和随访期间的复发率。
56 例患者可纳入本分析。PSH 修复术 89.3%为择期手术，73%为腹腔镜技术。50%同时存在切口疝（EHS 2 型和 4 型），并在单步手术中同时修复 PSH。需要再次手术（Clavien-Dindo ≥3b）的主要术后并发症发生率为 8.9%（5/56）。总体复发率为 12.5%（7/56）。中位随访时间为 38 个月，1 年随访率为 96.4%。
在腹腔镜和开放手术中，3D 漏斗形网状物在 IPOM 技术中修复 PSH 是安全、有效且易于操作的，与其他技术相比提供了有利的结果。此外，同时检测和治疗伴随的切口疝显示出有利的结果。然而，网兜会膨胀并缩短，包裹大块的肠系膜，并且偏心进一步收缩。根据漏斗的延长改变网兜的构造可能会降低复发率。
