Francesco Serra, Bonaduce Isabella, Cabry Francesca, Sorrentino Lorena, Iaquinta Tommaso, Fenocchi Sara, Roberta Gelmini
Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena Italy, Via del Pozzo, 71 41100, Modena, Italy.
Ann Med Surg (Lond). 2020 Nov 17;60:475-479. doi: 10.1016/j.amsu.2020.11.038. eCollection 2020 Dec.
Parastomal hernia is a type of incisional hernia occurring in abdominal integuments in the vicinity of a stoma. The best surgical approach for PSH remains controversial. Most studies report short follow-up time after surgery and a low number of cases to allow conclusions. Actually, we don't have a relevant recommendation about an optimal surgical technique or the most effective mesh for PSH repair.
Once packaged the latero-lateral mechanical anastomosis to restore the continuity of the intestinal tract of the patient, an adequate disinfection of trough of the stoma was done. The lateral and medial margins of the defect are then transposed towards each other and kept side by side with a gripper; a 60 mm tristaple linear stapler was placed, incorporating both edges and the charge is fired to obtain a perfect synthesis of the retromuscular plane.
In the literature has been described several surgical techniques for its repair: suture repair, relocation, mesh-based technique with open or laparoscopic approach. Both, the simple corrective surgery of Thorlakson in 1965 and the use of the peritoneomuscular flap for closing the defect, suggested by Bewes, led to high incidence of recurrence. An important reduction in the rate of parastomal hernia derives also from the mesh reinforcement of the stoma trephine.
The authors suggest that this technique should be help the surgeons to repair parastomal hernia in patients with multiple risk factors to develop a recurrence of parastomal hernia.
造口旁疝是一种发生在造口附近腹部皮肤的切口疝。造口旁疝的最佳手术方法仍存在争议。大多数研究报告的术后随访时间较短，病例数量较少，难以得出结论。实际上，对于造口旁疝修复的最佳手术技术或最有效的补片，我们尚无相关建议。
对患者进行侧方机械吻合以恢复肠道连续性后，对造口槽进行了充分消毒。然后将缺损的外侧和内侧边缘相互移位，并用夹具并排固定；放置一个60毫米的三排线性缝合器，将两边都纳入其中，击发后在肌后平面获得完美缝合。
文献中描述了几种用于修复的手术技术：缝合修复、重新定位、开放式或腹腔镜式基于补片的技术。1965年Thorlakson的简单矫正手术以及Bewes建议的使用腹膜肌瓣关闭缺损，均导致高复发率。造口旁疝发生率的显著降低也源于造口环的补片加强。
作者认为，这项技术应有助于外科医生修复具有多种造口旁疝复发风险因素患者的造口旁疝。
