Laparoscopic Repair of Parastomal Hernia

Parastomal hernia is a bulge formed by intra-abdominal tissue or organs that protrude into the dilated artificial cavity surrounding the abdominal stoma after patients undergo abdominal ostomy. It is one of the most common long-term complications after abdominal ostomy. Its overall incidence is ~5 to 81%, and the 1-year postoperative incidence is ~30 to 50%. Patients with parastomal hernia can present with skin irritation around the stoma, abdominal pain in the abdominal wall defect region, and difficulties with bowel movements. Severe cases might include incarcerated bowel loops that result in intestinal obstruction and necrosis. Parastomal hernia can reduce quality of life and represents a threat to the health and safety of patients severely. Surgery is the only cure for parastomal hernia. Local suture repair and repair with the relocation of the stoma have been associated with higher recurrence rates of hernia. Clinically, prosthetic material is commonly used to repair parastomal hernia. Over the past decade, the number of laparoscopic mesh repairs for parastomal hernia has gradually increased. Favorable results have been reported with regard to surgical safety, efficacy, and long-term follow-up assessments. Compared with traditional open surgical repairs for parastomal hernia, laparoscopic repair has certain advantages including its safe operation, postoperative rapid recovery, fewer complications, and lower recurrence rate. It has gradually become a widely accepted clinical practice. There are several major laparoscopic procedures for parastomal hernioplasty. The indications, technical details, and complications of them will be introduced and discussed in this article.

Keywords: parastomal hernia, laparoscopic repair, keyhole, Sugarbaker, Lap-re-do