A Novel Technique for the Repair of Urostomal Hernias Using Human Acellular Dermal Matrix

OBJECTIVE To report a new technique to reconstruct the abdominal wall at the site of the hernia with 2 separate layers of human acellular dermal matrix (hADM). Parastomal hernia is the most commonly encountered complication of ileal conduit urinary diversion, occurring at a rate of 5%-25%.(1-3) Multiple methods of parastomal hernia repair, including primary fascial repair, mesh repair, and stoma resiting have been reported, with a wide variety of approaches and materials being used. METHODS Between 2008 and 2009, 4 patients underwent surgical repair of urostomal hernias using hADM (LifeCell, Branchburg, NJ). All were operated on by a single surgeon using a standard technique of open repair whereby the posterior and anterior rectus fascia at the stoma site were reconstructed with hADM. Demographic data, preoperative and intraoperative risk factors, immediate postoperative complications, and hernia recurrence were collected and analyzed. RESULTS Four patients underwent urostomal hernia repair with Alloderm without intraoperative complications. Mean operative time was 261.25 +/- 80.8 minutes. Mean hospital stay was 9 +/- 3 days. With an average of 270 +/- 104-days' follow-up, there were no recurrent hernias detected. CONCLUSIONS In patients with urostomal hernia, reconstruction of the stoma site and abdominal wall with hADM appears to be a safe and effective management solution and avoids the difficulty with relocating the urostomy or placing prosthetic material in the site. UROLOGY 77: 746-750, 2011. (C) 2011 Elsevier Inc.