Mesh repair of parastomal hernias - a safety modification

Introduction: Parastomal herniation is not uncommon and numerous surgical approaches to the problem have been employed including mesh reinforcement. Bowel wall erosion is a worrying potential complication of placing an edge of mesh around bowel. To reduce this possibility a simple modification is suggested. Method: The polypropylene mesh repair is fashioned on the posterior rectus sheath. The required aperture for the bowel is marked appropriately on the mesh. Instead of simple removal of the marked circle, the aperture is fashioned by folding back and stitching in place the triangular flaps from the middle to form a rolled rather than sharp edge. Non-absorbable monofilament stitches reconstitute the mesh encirclement, and attach it laterally and medially to the aponeurotic tissue. A review of the case notes was conducted and each patient was contacted by a postal questionnaire. Results: This technique has been used in 10 patients (7 end colostomies, 2 end ileostomies and 1 loop ileostomy) since 2000. Over a median follow-up period of 30 months (range 2 to 40 months) there have been no hernia recurrences, no infected meshes, no bowel damage attributable to the mesh and no troubles with stoma. The only complication encountered has been a segment of superficial wound breakdown in one patient. Conclusions: This technique appears to offer a safe and reliable modification for mesh repair of parastomal herniation, in being designed to obviate the possibility of erosion of the stomal bowel wall by a sharp mesh edge but at the same time providing a sound herniorrhaphy by complete encirclement.