BACKGROUND In recent years,mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain.However,using mesh to repair parastomal hernias also carries ...BACKGROUND In recent years,mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain.However,using mesh to repair parastomal hernias also carries potential dangers.One of these dangers is mesh erosion,a rare but serious complication following hernia surgery,particularly parastomal hernia surgery,and has attracted the attention of surgeons in recent years.CASE SUMMARY Herein,we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery.The patient,who underwent parastomal hernia repair surgery 3 years prior,presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus.Three months later,a portion of the mesh was excreted from the patient’s anus and was removed by a doctor.Imaging revealed that the patient’s colon had formed a t-branch tube structure,which was formed by the mesh erosion.The surgery reconstructed the structure of the colon and eliminated potential bowel perforation.CONCLUSION Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.展开更多
AIM:To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS:A systematic review of PubMed and MEDLINE databases was conducted using various co...AIM:To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS:A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords:stoma repair,laparoscopic,parastomal,and hernia.Case reports,studies with less than 5 patients,and articles not written in English were excluded.Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine.Two authors reviewed and analyzed each study.If there was any discrepancy between scores,the study in question was referred to another author.A meta-analysis was performed using both random and fixed-effect models.Publication bias was evaluated using Begg's funnel plot and Egger's regression test.The primary outcome analyzed was recurrence of parastomal hernia.Secondary outcomes were mesh infection,surgical site infection,obstruction requiring reoperation,death,and other complications.Studies were grouped by operative technique where indicated.Except for recurrence,most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.RESULTS:Fifteen articles with a total of 469 patients were deemed eligible for review.Most postoperative morbidities were reported for the overall cohort,and not by approach.The overall postoperative morbidity rate was 1.8%(95%CI:0.8-3.2),and there was no difference between techniques.The most common postoperative complication was surgical site infection,which was seen in 3.8%(95%CI:2.3-5.7).Infected mesh was observed in 1.7%(95%CI:0.7-3.1),and obstruction requiring reoperation also occurred in 1.7%(95%CI:0.7-3.0).Other complications such as ileus,pneumonia,or urinary tract infection were noted in16.6%(95%CI:11.9-22.1).Eighty-one recurrences were reported overall for a recurrence rate of 17.4%(95%CI:9.5-26.9).The recurrence rate was 10.2%(95%CI:3.9-19.0) for the modified laparoscopic Sugarbaker approach,whereas the recurrence rate was27.9%(95%CI:12.3-46.9) for the keyhole approach.There were no intraoperative mortalities reported and six mortalities during the postoperative course.CONCLUSION:Laparoscopic intraperitoneal mesh repair is safe and effective for treating parastomal hernia.A modified Sugarbaker approach appears to provide the best outcomes.展开更多
AIMTo retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.METHODSA retrospective study was performed to analyze eight patients who u...AIMTo retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.METHODSA retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbakerhernia repair treatment. This modifed technique included an innovative three-point anchoring and complete su-turing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to eva-luate the safety and effcacy of this modifed technique.RESULTSOf these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modifed laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruc-tion of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 （visual analog scale method） at postoperative day 1. Two patientsdeveloped postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period （6-22 mo, average 13 mo）.CONCLUSIONThe modifed laparoscopic Sugarbaker repair could fx the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.展开更多
AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrenc...AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.展开更多
Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactoria...Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactorial. Parastomal ulceration, although rare, is a particularly difficult management problem. We conducted a literature search using MD Consult, Science Direct, OVID, Medline, and Cochrane Databases to review the causes and management options of parastomal ulceration. Both the etiology and treatments are varied. Different physicians and ostomy specialists have used a large array of methods to manage parastomal ulcers; these including local wound care; steroid creams; systemic steroids; and, when conservative measures fail, surgery. Most patients with parastomal ulcers who do not have associated IBD or peristomal pyoderma gangrenosum （PPG） often respond quickly to local wound care and conservative management. Patients with PPG, IBD, or other systemic causes of their ulceration need both systemic and local care and are more likely to need long term treatment and possibly surgical revision of the ostomy. The treatment is complicated, but improved with the help of ostomy specialists.展开更多
Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—on...Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—one to the small bowel and one to the skin. Their presentation, management and outcomes are described. Results: Both patients had parastomal hernias as the likely cause of their fistula formation. Discussion: Parastomal herniation may contribute to fistula formation due to a strangulated ischemic pressure necrosis of the adjacent ileal conduit and/or bowel.展开更多
Objective:To investigate the risk factors of parastomal hernia in patients with a colostomy.Methods:The related studies published in Embase,PubMed,CNKI,and other databases were searched.The search time limit was from ...Objective:To investigate the risk factors of parastomal hernia in patients with a colostomy.Methods:The related studies published in Embase,PubMed,CNKI,and other databases were searched.The search time limit was from the establishment of the database to March 2020.After the literature screening,data extraction and cross-checking were carried out independently by two researchers,the qualitative research method was used to summarize.Results:After screening,6 articles were included.The results of qualitative analysis showed that a total of 10 risk factors of parastomal hernia were concluded which could be classified into personal and colostomy factors.Conclusion:The current evidence showed that 10 risk factors such as age,Body Mass Index and colostomy were related to the occurrence of parastomal hernia in patients with a colostomy.Limited by the type and quantity of research,the above conclusions need to be verified by more high-quality research.展开更多
Background Parastomal hernia is one of the potential complications after enterostomy.There is currently no early risk assessment tool for parastomal hernia.Methods The current investigation was conducted using retrosp...Background Parastomal hernia is one of the potential complications after enterostomy.There is currently no early risk assessment tool for parastomal hernia.Methods The current investigation was conducted using retrospective studies.A total of 302 cases were used develop and internally to validate a nomogram prediction model,and 67 cases were used for external validation.Independent risk factors for parastomal hernia after permanent sigmoid colostomy were assessed via univariate analysis and binary logistic regression analysis.The nomogram prediction model was established based on independent risk factors.Results Body mass index,serum albumin,age,sex,and stoma diameter were independent risk factors for parastomal hernia.The areas under the receiver operating characteristic curves were 0.909 in the development group and 0.801 in the validation group.The Hosmer-Lemeshow test(P>0.05)and calibration curves indicated good consistency between actual observations and predicted probabilities.Conclusions A nomogram prediction model was constructed and validated based on risk factors for parastomal hernia.The nomogram could be generalized to patients undergoing surgery for stoma by specialized surgeons to provide relevant references for stoma patients.展开更多
Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been p...Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been proposed,there is no consensus on optimal management.Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences.In this review,we describe the incidence of parastomal hernias and discuss pertinent risk factors,medical history findings,physical examination findings,supplementary diagnostic modalities,parastomal hernia classification systems,surgical indications,and repair techniques.Special consideration is given to the discussion of mesh reinforcement,including available biomaterials,anatomic plane selection,and the extent of mesh reinforcement.Although open repairs are the primary focus of this article,minimally invasive laparoscopic and robotic approaches are also briefly described.It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.展开更多
A rare case of a severely constipated patient with rectal aganglionosis is herein reported.The patient,who had no megacolon/megarectum,underwent a STARR,i.e.,stapled transanal rectal resection,for obstructed defecatio...A rare case of a severely constipated patient with rectal aganglionosis is herein reported.The patient,who had no megacolon/megarectum,underwent a STARR,i.e.,stapled transanal rectal resection,for obstructed defecation,but her symptoms were not relieved.She started suffering from severe chronic proctalgia possibly due to peri-retained staples fibrosis.Intestinal transit times were normal and no megarectum/megacolon was found at barium enema.A diverting sigmoidostomy was then carried out,which was complicated by an early parastomal hernia,which affected stoma emptying.She also had a severe diverting proctitis,causing rectal bleeding,and still complained of both proctalgia and tenesmus.A deep rectal biopsy under anesthesia showed no ganglia in the rectum,whereas ganglia were present and normal in the sigmoid at the stoma site.As she refused a Duhamel procedure,an intersphincteric rectal resection and a refashioning of the stoma was scheduled.This case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure.展开更多
文摘BACKGROUND In recent years,mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain.However,using mesh to repair parastomal hernias also carries potential dangers.One of these dangers is mesh erosion,a rare but serious complication following hernia surgery,particularly parastomal hernia surgery,and has attracted the attention of surgeons in recent years.CASE SUMMARY Herein,we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery.The patient,who underwent parastomal hernia repair surgery 3 years prior,presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus.Three months later,a portion of the mesh was excreted from the patient’s anus and was removed by a doctor.Imaging revealed that the patient’s colon had formed a t-branch tube structure,which was formed by the mesh erosion.The surgery reconstructed the structure of the colon and eliminated potential bowel perforation.CONCLUSION Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.
文摘AIM:To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.METHODS:A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords:stoma repair,laparoscopic,parastomal,and hernia.Case reports,studies with less than 5 patients,and articles not written in English were excluded.Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine.Two authors reviewed and analyzed each study.If there was any discrepancy between scores,the study in question was referred to another author.A meta-analysis was performed using both random and fixed-effect models.Publication bias was evaluated using Begg's funnel plot and Egger's regression test.The primary outcome analyzed was recurrence of parastomal hernia.Secondary outcomes were mesh infection,surgical site infection,obstruction requiring reoperation,death,and other complications.Studies were grouped by operative technique where indicated.Except for recurrence,most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.RESULTS:Fifteen articles with a total of 469 patients were deemed eligible for review.Most postoperative morbidities were reported for the overall cohort,and not by approach.The overall postoperative morbidity rate was 1.8%(95%CI:0.8-3.2),and there was no difference between techniques.The most common postoperative complication was surgical site infection,which was seen in 3.8%(95%CI:2.3-5.7).Infected mesh was observed in 1.7%(95%CI:0.7-3.1),and obstruction requiring reoperation also occurred in 1.7%(95%CI:0.7-3.0).Other complications such as ileus,pneumonia,or urinary tract infection were noted in16.6%(95%CI:11.9-22.1).Eighty-one recurrences were reported overall for a recurrence rate of 17.4%(95%CI:9.5-26.9).The recurrence rate was 10.2%(95%CI:3.9-19.0) for the modified laparoscopic Sugarbaker approach,whereas the recurrence rate was27.9%(95%CI:12.3-46.9) for the keyhole approach.There were no intraoperative mortalities reported and six mortalities during the postoperative course.CONCLUSION:Laparoscopic intraperitoneal mesh repair is safe and effective for treating parastomal hernia.A modified Sugarbaker approach appears to provide the best outcomes.
文摘AIMTo retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.METHODSA retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbakerhernia repair treatment. This modifed technique included an innovative three-point anchoring and complete su-turing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to eva-luate the safety and effcacy of this modifed technique.RESULTSOf these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modifed laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruc-tion of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 （visual analog scale method） at postoperative day 1. Two patientsdeveloped postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period （6-22 mo, average 13 mo）.CONCLUSIONThe modifed laparoscopic Sugarbaker repair could fx the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.
文摘AIM To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.METHODS Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions （95%CI） were calculated using StatsDirect. Heterogeneity concerning outcome mea-sures was determined using Cochran’s Q test and was quantifed using I2. Random and fxed effects models were used. Meta-analysis was performed with Review Manager software with the statistical signifcance set at P ≤ 0.05.RESULTSForty-four studies were included： 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair （24.0% vs 15.1%, P = 0.01）. No significant difference was found concerning wound and mesh infection （5.6% vs 2.8%; 0% vs 3.1%）. Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia （OR = 0.20, P 〈 0.0006） without increasing wound infection [7.8% vs 8.2% （OR = 1.04, P = 0.91）] and without differences between the mesh types.
文摘Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactorial. Parastomal ulceration, although rare, is a particularly difficult management problem. We conducted a literature search using MD Consult, Science Direct, OVID, Medline, and Cochrane Databases to review the causes and management options of parastomal ulceration. Both the etiology and treatments are varied. Different physicians and ostomy specialists have used a large array of methods to manage parastomal ulcers; these including local wound care; steroid creams; systemic steroids; and, when conservative measures fail, surgery. Most patients with parastomal ulcers who do not have associated IBD or peristomal pyoderma gangrenosum （PPG） often respond quickly to local wound care and conservative management. Patients with PPG, IBD, or other systemic causes of their ulceration need both systemic and local care and are more likely to need long term treatment and possibly surgical revision of the ostomy. The treatment is complicated, but improved with the help of ostomy specialists.
文摘Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—one to the small bowel and one to the skin. Their presentation, management and outcomes are described. Results: Both patients had parastomal hernias as the likely cause of their fistula formation. Discussion: Parastomal herniation may contribute to fistula formation due to a strangulated ischemic pressure necrosis of the adjacent ileal conduit and/or bowel.
文摘Objective:To investigate the risk factors of parastomal hernia in patients with a colostomy.Methods:The related studies published in Embase,PubMed,CNKI,and other databases were searched.The search time limit was from the establishment of the database to March 2020.After the literature screening,data extraction and cross-checking were carried out independently by two researchers,the qualitative research method was used to summarize.Results:After screening,6 articles were included.The results of qualitative analysis showed that a total of 10 risk factors of parastomal hernia were concluded which could be classified into personal and colostomy factors.Conclusion:The current evidence showed that 10 risk factors such as age,Body Mass Index and colostomy were related to the occurrence of parastomal hernia in patients with a colostomy.Limited by the type and quantity of research,the above conclusions need to be verified by more high-quality research.
文摘Background Parastomal hernia is one of the potential complications after enterostomy.There is currently no early risk assessment tool for parastomal hernia.Methods The current investigation was conducted using retrospective studies.A total of 302 cases were used develop and internally to validate a nomogram prediction model,and 67 cases were used for external validation.Independent risk factors for parastomal hernia after permanent sigmoid colostomy were assessed via univariate analysis and binary logistic regression analysis.The nomogram prediction model was established based on independent risk factors.Results Body mass index,serum albumin,age,sex,and stoma diameter were independent risk factors for parastomal hernia.The areas under the receiver operating characteristic curves were 0.909 in the development group and 0.801 in the validation group.The Hosmer-Lemeshow test(P>0.05)and calibration curves indicated good consistency between actual observations and predicted probabilities.Conclusions A nomogram prediction model was constructed and validated based on risk factors for parastomal hernia.The nomogram could be generalized to patients undergoing surgery for stoma by specialized surgeons to provide relevant references for stoma patients.
文摘Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been proposed,there is no consensus on optimal management.Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences.In this review,we describe the incidence of parastomal hernias and discuss pertinent risk factors,medical history findings,physical examination findings,supplementary diagnostic modalities,parastomal hernia classification systems,surgical indications,and repair techniques.Special consideration is given to the discussion of mesh reinforcement,including available biomaterials,anatomic plane selection,and the extent of mesh reinforcement.Although open repairs are the primary focus of this article,minimally invasive laparoscopic and robotic approaches are also briefly described.It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.
文摘A rare case of a severely constipated patient with rectal aganglionosis is herein reported.The patient,who had no megacolon/megarectum,underwent a STARR,i.e.,stapled transanal rectal resection,for obstructed defecation,but her symptoms were not relieved.She started suffering from severe chronic proctalgia possibly due to peri-retained staples fibrosis.Intestinal transit times were normal and no megarectum/megacolon was found at barium enema.A diverting sigmoidostomy was then carried out,which was complicated by an early parastomal hernia,which affected stoma emptying.She also had a severe diverting proctitis,causing rectal bleeding,and still complained of both proctalgia and tenesmus.A deep rectal biopsy under anesthesia showed no ganglia in the rectum,whereas ganglia were present and normal in the sigmoid at the stoma site.As she refused a Duhamel procedure,an intersphincteric rectal resection and a refashioning of the stoma was scheduled.This case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure.
