Ando Ryohei, Sato Ryuichiro, Oikawa Masaya, Kakita Tetsuya, Okada Takaho, Tsuchiya Takashi
Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan; Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
Int J Surg Case Rep. 2020;71:107-111. doi: 10.1016/j.ijscr.2020.04.082. Epub 2020 May 12.
Parastomal hernia is one of the common complications of permanent stoma, and its incidence was nearly 50%. Surgical management is challenging and associated with relatively high recurrence rate. Mesh repair was demonstrated to reduce recurrence compared to non-mesh repair, and modified Surgerbaker and keyhole technique are the most cited intraperitoneal mesh repairs. In the keyhole technique, recurrence often occurs by herniation through the central hole. We present four parastomal hernia cases successfully repaired by modified keyhole technique, in which a cylinder-shaped synthetic mesh was attached to the keyhole mesh to cover the angle between the keyhole and the bowel.
There were 1 male and 3 females with mean BMI of 25.7 kg/m. Mean operative time was 114 min. There were two end-colostomies, one loop-ileostomy and one ileal conduit cases. Postoperative complication was observed in two cases, which was cerebral infarction and paralytic ileus. There were neither infectious complications nor seroma formation, and mean postoperative hospital stay was 18 days. With mean follow-up time of 36 months (range 10-66), we experienced no recurrence.
Having lower recurrence rate, the modified Sugerbaker technique is considered preferable over the keyhole technique, but the bowel going to the stoma needs to be lateralized enough to be covered by relatively large mesh, which is not always accomplished. In such instances, our modified keyhole technique would be a feasible alternative.
造口旁疝是永久性造口常见的并发症之一，其发生率近50%。手术治疗具有挑战性且复发率相对较高。与非补片修补相比，补片修补已被证明可降低复发率，改良的Surgerbaker修补术和钥匙孔技术是最常被引用的腹腔内补片修补术。在钥匙孔技术中，复发常通过中央孔疝出而发生。我们报告了4例采用改良钥匙孔技术成功修补的造口旁疝病例，其中在钥匙孔补片上附加了一个圆柱形合成补片，以覆盖钥匙孔与肠管之间的夹角。
患者1例男性，3例女性，平均体重指数为25.7kg/m。平均手术时间为114分钟。其中有2例末端结肠造口术、1例袢式回肠造口术和1例回肠膀胱术病例。2例患者出现术后并发症，分别为脑梗死和麻痹性肠梗阻。既无感染性并发症也无血清肿形成，术后平均住院时间为18天。平均随访时间为36个月（范围10 - 66个月），未出现复发情况。
改良的Sugerbaker技术复发率较低，被认为优于钥匙孔技术，但通向造口的肠管需要充分侧向移位以被相对较大的补片覆盖，而这并非总能实现。在这种情况下，我们的改良钥匙孔技术将是一种可行的替代方法。
