Olmi Stefano, Oldani Alberto, Uccelli Matteo, Scotto Bruno, Cesana Giovanni, Ciccarese Francesca, Villa Roberta, Giorgi Riccardo
General and Oncological Surgery Unit, Policlinico San Marco GSD, Osio Sotto, Italy.
J Laparoendosc Adv Surg Tech A. 2019 May;29(5):681-684. doi: 10.1089/lap.2018.0730. Epub 2019 Feb 15.
Although the modified Sugarbaker technique gives good results for the treatment of parastomal hernia (PH), there are other valid options for the treatment of this frequent complication. In our practice, the laparoscopic keyhole (KH) technique, with some specific modifications, can give similar results. We collected data on all the patients with symptomatic PHs who underwent surgical repair between January 2002 and December 2017 in our surgical department. The primary endpoint was to evaluate the recurrence rate after at least 1 year, determined on the basis of physical examination during follow-up and on postprocedure radiological results. Ninety patients were treated with the KH technique. The stomas that were treated were 83 end colostomies and 7 ileal ureterostomies. Eighty-eight patients were treated with polyester mesh (Parietex™, Medtronic, Ireland) and 2 with a composite mesh (Physiomesh™, Ethicon). Patients had median follow-up period of 1 year. Seroma occurred in 4 patients, who were treated conservatively by clinical monitoring. Four patients had a recurrence: 1 occurred on the seventh postoperative day, due to a technical error; 1 after 6 months, due to the partial shrinkage of the mesh into the defect; the third after 1 year, but it occurred at the beginning of our experience, and the last recurrence was after 3 years in a patient who gained 15 kg after the procedure. If a few precautionary steps are added to the original technique, laparoscopic KH repair is feasible and safe, giving good results in terms of complications and recurrence rates.
尽管改良的Sugarbaker技术在治疗造口旁疝（PH）方面取得了良好效果，但对于这种常见并发症的治疗还有其他有效的选择。在我们的实践中，经过一些特定改良的腹腔镜钥匙孔（KH）技术可以取得类似的效果。我们收集了2002年1月至2017年12月期间在我们外科接受手术修复的所有有症状PH患者的数据。主要终点是根据随访期间的体格检查和术后影像学结果评估至少1年后的复发率。90例患者接受了KH技术治疗。所治疗的造口包括83个结肠端式造口和7个回肠输尿管造口。88例患者使用聚酯补片（Parietex™，美敦力公司，爱尔兰）治疗，2例使用复合补片（Physiomesh™，爱惜康公司）治疗。患者的中位随访期为1年。4例患者出现血清肿，通过临床监测进行保守治疗。4例患者复发：1例在术后第7天因技术失误复发；1例在6个月后因补片部分缩入缺损处复发；第3例在1年后复发，但发生在我们经验初期，最后1例复发是在术后3年，该患者术后体重增加了15千克。如果在原技术基础上增加一些预防措施，腹腔镜KH修复是可行且安全的，在并发症和复发率方面都能取得良好效果。
