Parastomal hernias successfully repaired using a modified components separation method: two case reports

Journal of Medical Case Reports

Katsuhiko Yanaga²  Tomoyoshi Okamoto¹  Shintaro Nakajima²  Toshiaki Suzuki¹  Ken Hanyu¹  Katsuhito Suwa¹ 

[1] Department of Surgery, Jikei University School of Medicine, Daisan Hospital, 4-11-1 Izumihoncho, Komae-city, Tokyo 201-8601, Japan;Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-0003, Japan

关键词: Repair;    Incisional hernia;    Components separation method;    Parastomal hernia;   

Others  :  1181139
DOI  :  10.1186/1752-1947-7-180

 received in 2012-12-13, accepted in 2013-05-15,  发布年份 2013

【 摘 要 】

Introduction

Parastomal hernia is a frequent complication after enterostomy formation. A repair using prosthetic mesh by way of a laparoscopic or open transabdominal approach is usually recommended, however, other procedures may be done if the repair is to be performed in a contaminated environment or when the abdominal cavity of the patient is difficult to enter due to postsurgical dense adhesion. The components separation method, which was introduced for non-transabdominal and non-prosthetic ventral hernia repair, solves such problems.

Case presentation

Case 1. A 79-year-old Japanese woman who underwent total cystectomy with ileal conduit for bladder cancer presented with a parastomal hernia, which was repaired using a keyhole technique. Simultaneously, an incisional hernia in the midline was repaired with a prosthetic mesh. One year after her hernia surgery, a recurrence occurred lateral to the stoma, but it was believed to be difficult to enter the peritoneal cavity because of the wide placement of mesh. Therefore, surgery using the components separation method was performed.

Case 2. A 72-year-old Japanese man underwent an abdominoperineal resection for rectal cancer. At 5 and 12 months after his operation, a perineal hernia and an incisional hernia in the midline were repaired with prosthesis using a transabdominal approach, respectively. Three years after his rectal surgery, a parastomal hernia developed lateral to the stoma. For the same reason as case 1, surgery using the components separation method was performed. No recurrence was observed in either case as of 40 and 8 months after the last repair, respectively.

Conclusion

The components separation method is a novel and effective technique for parastomal hernia repair, especially in cases following abdominal polysurgery or midline incisional hernia repairs using large pieces of mesh. To the best of our knowledge, this is the first report in English on the application of the components separation method for parastomal hernia repair.

【 授权许可】

   
2013 Suwa et al.; licensee BioMed Central Ltd.

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【 参考文献 】

• [1]Carne PWG, Robertson GM, Frizelle FA: Parastomal hernia. Br J Surg 2003, 90:784-793.
• [2]Rubin MS, Schoetz DJ, Matthews JB: Is stoma relocation superior to fascial repair? Arch Surg 1994, 129:413-419.
• [3]Cheung MT, Chia NH, Chiu WY: Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 2001, 44:266-270.
• [4]Rieger N, Moore J, Hewett P, Lee S, Stephens J: Parastomal hernia repair. Colorectal Dis 2004, 6:203-205.
• [5]Riansuwan W, Hull TL, Millan MM, Hammel JP: Surgery of recurrent parastomal hernia: direct repair or relocation? Colorectal Dis 2010, 12:681-686.
• [6]Pastor DM, Pauli EM, Koltun WA, Haluck RS, Shope TR, Poritz LS: Parastomal hernia repair: a single center experience. JSLS 2009, 13:170-175.
• [7]Leslie D: The parastomal hernia. Surg Clin N Am 1984, 64:407-415.
• [8]Thorlakson RH: Technique of repair of herniations associated with colonic stomas. Surg Gynecol Obstet 1965, 120:347-350.
• [9]Allen-Mersh TG, Thomson JPS: Surgical treatment of colostomy complications. Br J Surg 1988, 75:416-418.
• [10]Hansson BME, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP: Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 2012, 255:685-695.
• [11]Sugarbaker PH: Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann Surg 1985, 201:344-346.
• [12]Ramirez OM, Ruas E, Dellon AL: “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990, 86:519-526.
• [13]Nakajima S, Suwa K, Ohtsu M, Kitagawa K, Okuma M, Fuijta A, Yamagata T, Okamoto T, Kashiwagi H, Yanaga K: Repair of recurrent parastomal hernia with a components separation technique: a case report [in Japanese with English Abstract]. J Jpn Soc Coloproctol 2010, 63:228-234.