This document summarizes information on parastomal hernias (PSH), including:
- PSH incidence varies widely depending on stoma type but can be as high as 48% for end colostomies.
- Risk factors include smoking, obesity, diabetes, and conditions that increase intra-abdominal pressure.
- Mesh repair results in significantly lower recurrence rates than simple fascial repair, with rates under 20% for mesh.
- Prophylactic mesh placement during primary stoma formation may reduce PSH incidence without increasing complications, though existing RCTs have poor quality. Further research is still needed to determine optimal techniques.
The document discusses guidelines for the prevention and treatment of parastomal hernias. It finds that the incidence of parastomal hernias is 30-50% depending on follow up time, with terminal colostomies having a higher risk than lateral colostomies or ileostomies. Risk factors include age, obesity, infection and surgical technique. Mesh repair during hernia surgery results in lower recurrence rates of 7-17% compared to 69.4% for primary suture repair. Laparoscopic and open intraperitoneal mesh techniques have recurrence rates of around 10%. Prophylactic mesh placement during stoma creation may decrease hernia rates.
1. Parastomal hernias occur when viscus penetrates the abdominal wall around ostomies like colostomies and ileostomies. Inadequate wound healing between the ostomy tunnel and abdominal wall causes hernias.
2. Parastomal hernias are classified by location as subcutaneous, interstitial, perstomal, or intrastomal.
3. Surgical repair techniques include relocating the stoma, direct repair with or without mesh, indirect repair using mesh, and laparoscopic repair. Placement of a prophylactic mesh may reduce hernia rates.
Slideshow of Laparoscopic Surgery by Prof. R.K. Mishra Prof. R.K. Mishra has the distinction of being first Asian who is honoured as Professor of Minimal Access Surgery by legislated University of Govt. of India. He is is currently the most experienced professor of minimal surgery in the world who has alone as a single faculty trained more than 3000 surgeon and gynaecologists from 108 countries. http://www.laparoscopyhospital.com/drrkmishra.htm
NOTES (Natural Orifice Transluminal Endoscopic Surgery)- By Dr. Onkardronkarsingh
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an experimental surgical technique that performs abdominal operations through natural orifices like the mouth, urethra, anus or vagina without external incisions. NOTES aims to reduce surgical trauma and pain for patients by avoiding incisions. It also shortens recovery time and eliminates risks of complications from external incisions like infections and hernias. While still in development, NOTES shows promise as a less invasive future of surgery.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
Stoma complications by Prof. Ajay Khanna, IMS, BHU, Varanasi IndiaDivya Khanna
This document summarizes complications related to stomas and their management. It discusses various early and late complications including ischemia/necrosis, retraction/stenosis, skin irritation/rash, ileostomy diarrhea, bowel obstruction, prolapse, parastomal hernia, granuloma, and varices. It outlines risk factors and prevention strategies for different complications. Surgical and nonsurgical management options are provided depending on the severity of each complication. The importance of proper preoperative planning, surgical technique, and postoperative education are emphasized to minimize complication rates.
Golden steps to perform laparoscopic sleeve gastrectomyDeep Goel
Laparoscopic sleeve gastrectomy is one of the popular procedure performed in morbidly obese patients to achieve significant weight loss upto 80%. We are explaining golden tips to perform safer sleeve gastrectomy surgery from surgeons perspective.
Robotic sacrocolpopexy is a minimally invasive technique for repairing pelvic organ prolapse that provides excellent functional and anatomical results with limited risks. It allows for a complete correction of prolapse in the anterior, posterior, and apical compartments using a single approach. Studies show robotic sacrocolpopexy has comparable outcomes to open surgery with less blood loss and shorter hospital stays. While the technique has a learning curve, it may have advantages over conventional laparoscopy due to its 3D visualization and instrument dexterity.
The document discusses guidelines for the prevention and treatment of parastomal hernias. It finds that the incidence of parastomal hernias is 30-50% depending on follow up time, with terminal colostomies having a higher risk than lateral colostomies or ileostomies. Risk factors include age, obesity, infection and surgical technique. Mesh repair during hernia surgery results in lower recurrence rates of 7-17% compared to 69.4% for primary suture repair. Laparoscopic and open intraperitoneal mesh techniques have recurrence rates of around 10%. Prophylactic mesh placement during stoma creation may decrease hernia rates.
1. Parastomal hernias occur when viscus penetrates the abdominal wall around ostomies like colostomies and ileostomies. Inadequate wound healing between the ostomy tunnel and abdominal wall causes hernias.
2. Parastomal hernias are classified by location as subcutaneous, interstitial, perstomal, or intrastomal.
3. Surgical repair techniques include relocating the stoma, direct repair with or without mesh, indirect repair using mesh, and laparoscopic repair. Placement of a prophylactic mesh may reduce hernia rates.
Slideshow of Laparoscopic Surgery by Prof. R.K. Mishra Prof. R.K. Mishra has the distinction of being first Asian who is honoured as Professor of Minimal Access Surgery by legislated University of Govt. of India. He is is currently the most experienced professor of minimal surgery in the world who has alone as a single faculty trained more than 3000 surgeon and gynaecologists from 108 countries. http://www.laparoscopyhospital.com/drrkmishra.htm
NOTES (Natural Orifice Transluminal Endoscopic Surgery)- By Dr. Onkardronkarsingh
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an experimental surgical technique that performs abdominal operations through natural orifices like the mouth, urethra, anus or vagina without external incisions. NOTES aims to reduce surgical trauma and pain for patients by avoiding incisions. It also shortens recovery time and eliminates risks of complications from external incisions like infections and hernias. While still in development, NOTES shows promise as a less invasive future of surgery.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
Stoma complications by Prof. Ajay Khanna, IMS, BHU, Varanasi IndiaDivya Khanna
This document summarizes complications related to stomas and their management. It discusses various early and late complications including ischemia/necrosis, retraction/stenosis, skin irritation/rash, ileostomy diarrhea, bowel obstruction, prolapse, parastomal hernia, granuloma, and varices. It outlines risk factors and prevention strategies for different complications. Surgical and nonsurgical management options are provided depending on the severity of each complication. The importance of proper preoperative planning, surgical technique, and postoperative education are emphasized to minimize complication rates.
Golden steps to perform laparoscopic sleeve gastrectomyDeep Goel
Laparoscopic sleeve gastrectomy is one of the popular procedure performed in morbidly obese patients to achieve significant weight loss upto 80%. We are explaining golden tips to perform safer sleeve gastrectomy surgery from surgeons perspective.
Robotic sacrocolpopexy is a minimally invasive technique for repairing pelvic organ prolapse that provides excellent functional and anatomical results with limited risks. It allows for a complete correction of prolapse in the anterior, posterior, and apical compartments using a single approach. Studies show robotic sacrocolpopexy has comparable outcomes to open surgery with less blood loss and shorter hospital stays. While the technique has a learning curve, it may have advantages over conventional laparoscopy due to its 3D visualization and instrument dexterity.
Diagnostic staging laparoscopy (DSL) is performed to determine the feasibility of cancer resection and complement preoperative imaging with its limitations. DSL has a high accuracy and yield in detecting unresectable disease. It identifies patients who may benefit from neoadjuvant therapy rather than upfront surgery. The risk of complications from DSL is low at 0-2.5% morbidity and no mortality. Laparoscopic ultrasound can further aid staging but does not clearly offer advantages over laparoscopy alone. DSL provides important information to guide management decisions for gastrointestinal malignancies.
Indiapiles is the best hospital in pune .we provide miph and pph treatment for piles .It is a procedure that was originally conceived in 1994 by Dr Antonio Longo, and since,has gained popularity as the treatment of choice for Grade 3 and Grade 4 prolapsed Piles.
PARASTOMAL HERNIA : An ostomy is an artificial opening through the abdominal wall for the intestine or ureter in order to discharge feces or urine. Hernias that are associated with colostomies, ileostomies, jejunostomies or urostomies, where viscus penetrates the abdominal wall are called as paraostomal hernias
Baseball diamond concept for port position in laparoscopyJibran Mohsin
1) The document proposes the "Baseball Diamond Concept" for optimal port placement in laparoscopy, with three main principles: the primary port and working ports should be placed with half the instrument inside and half outside the abdomen; the primary port should be positioned between the working ports to allow for depth perception; and the manipulation angle between working instruments should be approximately 60 degrees.
2) It explains the rationales for each principle, including lever mechanics, elevation angles, avoidance of direct coupling between instruments and ports, and optimal depth perception with a contralateral primary port position.
3) Guidelines are provided for measuring and applying the concepts based on the target of dissection and average instrument lengths and hand sizes.
The document provides details on the anatomy and technique for performing a laparoscopic totally extra-peritoneal (TEP) approach for groin hernia repair. Key steps include: 1) gaining access to the pre-peritoneal space through an infraumbilical incision; 2) inserting additional ports under direct vision; 3) completing dissection of the pre-peritoneal space to expose the hernia; and 4) placing a large piece of mesh without fixation to cover the hernia defect. Important anatomical structures are identified during dissection, including the inferior epigastric vessels and vas deferens, to properly expose direct and indirect hernias.
Past present future - laparoscopic colorectal surgerypiyushpatwa
Laparoscopic colorectal surgery has become widely adopted, with up to 60% of elective colectomies performed laparoscopically. While technically demanding, laparoscopic surgery has been shown to be associated with lesser pain, earlier recovery, and shorter hospital stays compared to open surgery. For colorectal cancer, large randomized controlled trials found no differences in oncologic outcomes between laparoscopic and open surgery. New technologies like single-incision laparoscopy, robotics, and natural orifice translumenal endoscopic surgery continue to expand the applicability of minimally invasive approaches for complex colorectal procedures.
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
1) Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that uses an endoscope passed through natural openings like the mouth, vagina, or anus to perform internal surgery without external incisions.
2) NOTES was first described in animal models in the early 2000s and the first human transgastric cholecystectomy was reported in 2007.
3) While offering advantages over laparoscopy by avoiding external incisions, NOTES faces challenges of developing improved flexible instruments, closing access sites without leaks, and standardizing safe techniques.
Resection & anastomosis of boweL its complications PRANAYA PPTPRANAYA PANIGRAHI
This document discusses intestinal resection and anastomosis. It defines anastomosis as establishing communication between two portions of intestine after removal of diseased bowel. Factors that influence healing, techniques for performing anastomoses (hand sewn vs. stapling), and common complications are described. Maintaining adequate blood supply, tension-free closure, and paying attention to technical details are emphasized for achieving successful anastomotic healing.
The document discusses ventral hernias, including:
- Incidence and risk factors for ventral hernias
- Options for mesh placement during hernia repair surgery
- Types of prosthetic meshes used, including benefits and disadvantages of polypropylene, ePTFE, polyester, and absorbable barrier-coated meshes
- Studies comparing surgical outcomes and complications between different mesh types
Ureteral injury is one of the most serious complications of gynecologic surgery. Ureteral injury during laparoscopic surgery has become more common as a result of the increased number of laparoscopic hysterectomies and retroperitoneal procedures that are being performed.
Transgastric and transvaginal endoscopic cholecystectomy procedures were performed in 27 patients between 2007-2008. The procedures were performed using hybrid NOTES techniques, with laparoscopic assistance. Both transgastric and transvaginal routes were utilized to access the peritoneal cavity. The authors present their initial experience with these novel natural orifice techniques for cholecystectomy in humans.
Two years before surgery, the surgeon must prepare themselves through skills training, observing other surgeons, and ensuring the operating room (OR) and team are ready. One week before, the surgeon confirms the indication for surgery, reviews contraindications and counsels the patient. The day before, the patient receives instructions and the surgeon ensures the OR and team are prepared. On the day of surgery, the surgeon obtains consent, checks equipment and the anesthetized patient is brought to the OR. Special considerations are discussed for obese, pregnant and high risk patients.
Mesh infection is one of most disastrous complication following hernia surgery. The consequences are more complex especially following a laparoscopic hernia repair operation. Understanding the pathophysiology of mesh infections is pivotal in adopting preventive strategies. Once infected, exact determination of the extent of the septic complication by CECT is essential. A two staged surgical intervention yields excellent results. A case of infected laparoscopic mesh repair treated by a two staged operation is presented along with a brief review of literature to highlight the safety and efficacy of this approach.
Surgical COnsiderations of Ostomy CreationAli Chami
An 87-year-old female presented with abdominal pain, distention and constipation. Imaging showed a perforated sigmoid colon requiring a sigmoidectomy and Hartmann's procedure. Pathology found sigmoid diverticulitis. She was discharged but readmitted 2.5 months later for elective colostomy closure. Guidelines were presented on ostomy creation and closure techniques to reduce complications like hernias. Evidence supports laparoscopic and loop ileostomy approaches when possible. Proper stoma construction and postoperative care can prevent issues like dehydration that lead to readmission.
Minimal access surgery (MAS) a new surgical and interventional approach, was called by different name and one of the popular is minimally invasive surgery. However,unique complications are associated.
The document discusses ureterovaginal fistulas (UVFs), including their causes, risk factors, presentations, diagnostic evaluations, and management approaches. It notes that UVFs are most often caused by gynecologic or obstetric surgeries, with iatrogenic injury occurring in 0.5-2.5% of such procedures. Clinical presentation varies depending on the timing, from abdominal/flank pain immediately post-op to continuous urinary leakage from the vagina in delayed cases. Diagnostic tests include imaging like IVU, CT, MRI, and RGP to identify the fistula. Management involves upper tract drainage via nephrostomy or stenting, with early surgical repair via ureter
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
Parastomal hernias are a common complication of intestinal ostomies, occurring in 35-50% of patients. Recent studies have explored prophylactic mesh placement during primary stoma formation to prevent parastomal hernias, finding a significant reduction in hernia rates compared to no mesh. However, the quality of evidence is still limited. Ongoing research focuses on techniques like stapled mesh reinforcement to further establish the benefits of prophylactic mesh in preventing these hernias.
Diagnostic staging laparoscopy (DSL) is performed to determine the feasibility of cancer resection and complement preoperative imaging with its limitations. DSL has a high accuracy and yield in detecting unresectable disease. It identifies patients who may benefit from neoadjuvant therapy rather than upfront surgery. The risk of complications from DSL is low at 0-2.5% morbidity and no mortality. Laparoscopic ultrasound can further aid staging but does not clearly offer advantages over laparoscopy alone. DSL provides important information to guide management decisions for gastrointestinal malignancies.
Indiapiles is the best hospital in pune .we provide miph and pph treatment for piles .It is a procedure that was originally conceived in 1994 by Dr Antonio Longo, and since,has gained popularity as the treatment of choice for Grade 3 and Grade 4 prolapsed Piles.
PARASTOMAL HERNIA : An ostomy is an artificial opening through the abdominal wall for the intestine or ureter in order to discharge feces or urine. Hernias that are associated with colostomies, ileostomies, jejunostomies or urostomies, where viscus penetrates the abdominal wall are called as paraostomal hernias
Baseball diamond concept for port position in laparoscopyJibran Mohsin
1) The document proposes the "Baseball Diamond Concept" for optimal port placement in laparoscopy, with three main principles: the primary port and working ports should be placed with half the instrument inside and half outside the abdomen; the primary port should be positioned between the working ports to allow for depth perception; and the manipulation angle between working instruments should be approximately 60 degrees.
2) It explains the rationales for each principle, including lever mechanics, elevation angles, avoidance of direct coupling between instruments and ports, and optimal depth perception with a contralateral primary port position.
3) Guidelines are provided for measuring and applying the concepts based on the target of dissection and average instrument lengths and hand sizes.
The document provides details on the anatomy and technique for performing a laparoscopic totally extra-peritoneal (TEP) approach for groin hernia repair. Key steps include: 1) gaining access to the pre-peritoneal space through an infraumbilical incision; 2) inserting additional ports under direct vision; 3) completing dissection of the pre-peritoneal space to expose the hernia; and 4) placing a large piece of mesh without fixation to cover the hernia defect. Important anatomical structures are identified during dissection, including the inferior epigastric vessels and vas deferens, to properly expose direct and indirect hernias.
Past present future - laparoscopic colorectal surgerypiyushpatwa
Laparoscopic colorectal surgery has become widely adopted, with up to 60% of elective colectomies performed laparoscopically. While technically demanding, laparoscopic surgery has been shown to be associated with lesser pain, earlier recovery, and shorter hospital stays compared to open surgery. For colorectal cancer, large randomized controlled trials found no differences in oncologic outcomes between laparoscopic and open surgery. New technologies like single-incision laparoscopy, robotics, and natural orifice translumenal endoscopic surgery continue to expand the applicability of minimally invasive approaches for complex colorectal procedures.
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
1) Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that uses an endoscope passed through natural openings like the mouth, vagina, or anus to perform internal surgery without external incisions.
2) NOTES was first described in animal models in the early 2000s and the first human transgastric cholecystectomy was reported in 2007.
3) While offering advantages over laparoscopy by avoiding external incisions, NOTES faces challenges of developing improved flexible instruments, closing access sites without leaks, and standardizing safe techniques.
Resection & anastomosis of boweL its complications PRANAYA PPTPRANAYA PANIGRAHI
This document discusses intestinal resection and anastomosis. It defines anastomosis as establishing communication between two portions of intestine after removal of diseased bowel. Factors that influence healing, techniques for performing anastomoses (hand sewn vs. stapling), and common complications are described. Maintaining adequate blood supply, tension-free closure, and paying attention to technical details are emphasized for achieving successful anastomotic healing.
The document discusses ventral hernias, including:
- Incidence and risk factors for ventral hernias
- Options for mesh placement during hernia repair surgery
- Types of prosthetic meshes used, including benefits and disadvantages of polypropylene, ePTFE, polyester, and absorbable barrier-coated meshes
- Studies comparing surgical outcomes and complications between different mesh types
Ureteral injury is one of the most serious complications of gynecologic surgery. Ureteral injury during laparoscopic surgery has become more common as a result of the increased number of laparoscopic hysterectomies and retroperitoneal procedures that are being performed.
Transgastric and transvaginal endoscopic cholecystectomy procedures were performed in 27 patients between 2007-2008. The procedures were performed using hybrid NOTES techniques, with laparoscopic assistance. Both transgastric and transvaginal routes were utilized to access the peritoneal cavity. The authors present their initial experience with these novel natural orifice techniques for cholecystectomy in humans.
Two years before surgery, the surgeon must prepare themselves through skills training, observing other surgeons, and ensuring the operating room (OR) and team are ready. One week before, the surgeon confirms the indication for surgery, reviews contraindications and counsels the patient. The day before, the patient receives instructions and the surgeon ensures the OR and team are prepared. On the day of surgery, the surgeon obtains consent, checks equipment and the anesthetized patient is brought to the OR. Special considerations are discussed for obese, pregnant and high risk patients.
Mesh infection is one of most disastrous complication following hernia surgery. The consequences are more complex especially following a laparoscopic hernia repair operation. Understanding the pathophysiology of mesh infections is pivotal in adopting preventive strategies. Once infected, exact determination of the extent of the septic complication by CECT is essential. A two staged surgical intervention yields excellent results. A case of infected laparoscopic mesh repair treated by a two staged operation is presented along with a brief review of literature to highlight the safety and efficacy of this approach.
Surgical COnsiderations of Ostomy CreationAli Chami
An 87-year-old female presented with abdominal pain, distention and constipation. Imaging showed a perforated sigmoid colon requiring a sigmoidectomy and Hartmann's procedure. Pathology found sigmoid diverticulitis. She was discharged but readmitted 2.5 months later for elective colostomy closure. Guidelines were presented on ostomy creation and closure techniques to reduce complications like hernias. Evidence supports laparoscopic and loop ileostomy approaches when possible. Proper stoma construction and postoperative care can prevent issues like dehydration that lead to readmission.
Minimal access surgery (MAS) a new surgical and interventional approach, was called by different name and one of the popular is minimally invasive surgery. However,unique complications are associated.
The document discusses ureterovaginal fistulas (UVFs), including their causes, risk factors, presentations, diagnostic evaluations, and management approaches. It notes that UVFs are most often caused by gynecologic or obstetric surgeries, with iatrogenic injury occurring in 0.5-2.5% of such procedures. Clinical presentation varies depending on the timing, from abdominal/flank pain immediately post-op to continuous urinary leakage from the vagina in delayed cases. Diagnostic tests include imaging like IVU, CT, MRI, and RGP to identify the fistula. Management involves upper tract drainage via nephrostomy or stenting, with early surgical repair via ureter
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
Parastomal hernias are a common complication of intestinal ostomies, occurring in 35-50% of patients. Recent studies have explored prophylactic mesh placement during primary stoma formation to prevent parastomal hernias, finding a significant reduction in hernia rates compared to no mesh. However, the quality of evidence is still limited. Ongoing research focuses on techniques like stapled mesh reinforcement to further establish the benefits of prophylactic mesh in preventing these hernias.
- Dr. v.veeranath reddy presented on a study comparing outcomes of stapled vs handsewn anastomoses for lower gastrointestinal malignancies.
- 60 patients underwent either stapled (30 patients) or handsewn (30 patients) anastomoses. Mean operating time was shorter for stapled anastomoses.
- Patients who received stapled anastomoses resumed oral feeding 1 day earlier on average. There was no significant difference in hospital stay, infection rates, or leak rates between the two groups. The study concluded stapling devices can reduce operating time and allow for earlier feeding, but do not impact other outcomes compared to handsewn anastomoses.
Endoscopic submucosal dissection of gastric neoplastic12Taisir Shahriar
1) A systematic review was conducted of studies reporting on ESD of gastric neoplastic lesions in patients with liver cirrhosis. The review identified 68 ESD procedures in 61 cirrhotic patients reported in 3 studies.
2) En bloc resection was successful in 88.2% of cases and complete (R0) resection in 89.7% of cases. Post-procedure bleeding occurred in 13.1% of patients and was managed endoscopically.
3) Patients with more advanced cirrhosis (Child-Pugh class B/C) had a higher risk of bleeding compared to those with less severe disease (Child-Pugh class A). No procedure-related deaths occurred.
RCT on Base tie in laparoscopic appendecomy (Journal Club).pptxadnanhabib31
This is ppt made on a study based on Randomised controlled trial on the tie of appendix base in laparoscopic appendectomy by hem-o-lok,endoloop or stapler.This study showed that hem-o-lok clips are better and cheaper as compared to others.
This study evaluated the efficacy of laparoscopically assisted high ligation of patent processus vaginalis in 40 children aged 6 months to 7 years. The laparoscopic procedure detected unsuspected contralateral hernias in 28.1% of cases, without increasing operative time. All procedures were completed without complications. The mean operative time was 25 minutes for unilateral hernias and 35 minutes for bilateral cases. The mean post-operative hospital stay was 4 hours. One recurrence occurred among 57 hernias repaired over an average 18-month follow-up. Laparoscopic repair was found to be a safe and effective procedure for detecting and repairing hernias in children.
Sino Nasal malignancy & Anterior skull base surgery, Endoscopy is the best ???Ajay Manickam
1) The document compares endoscopic versus open surgery for sinonasal and anterior skull base tumors. It finds that endoscopic surgery provides comparable oncologic outcomes to open surgery, with lower morbidity, faster recovery, and shorter hospital stays.
2) A review of studies found no difference in margins or survival between the two approaches. Endoscopic surgery was associated with significantly shorter hospital stays.
3) Complications were also lower with endoscopic surgery. While open surgery remains necessary in some complex cases, endoscopic surgery is presented as a valid alternative for most sinonasal and anterior skull base malignancies.
Importance of a follow up ultrasound protocol in monitoringPrasunDas31
This document summarizes a study on the importance of follow-up ultrasounds in monitoring complications for children treated non-operatively for splenic injuries. The study found that 21% of children developed complications like hematomas, pseudocysts, and abscesses, detected by ultrasounds at 4 and 12 weeks post-injury. Establishing a standardized follow-up ultrasound protocol is important for early detection of complications in the critical 1-3 month period after trauma.
Cold Snare Polypectomy for Large Sessile Colonic Polyps: A Single-Center Expe...ENDONOTICIAS
This study retrospectively analyzed outcomes of using cold snare polypectomy (CSP) to remove large (≥10 mm) sessile colon polyps in 30 patients. CSP was found to be feasible for large polyps, with no adverse events and a 20% residual polyp rate on follow-up colonoscopy. While limited by its retrospective design, this study suggests CSP may safely and effectively remove large polyps. Further prospective research is needed to determine optimal CSP techniques and compare efficacy to standard polypectomy.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Evaluation of Stapled versus Hand-Sewn Techniques for Colo- Rectal Anastomosi...Dr./ Ihab Samy
This study compares outcomes of 50 patients who underwent colorectal anastomosis after low anterior resection for mid-rectal cancer using either stapled or hand-sewn techniques. The mean operative and anastomosis times were shorter for the stapled group compared to the hand-sewn group. Post-operative complications like anastomotic leakage, wound infection, and ileus occurred in similar rates between the two groups. The study concluded that colorectal anastomosis after low anterior resection for mid-rectal carcinoma can be performed safely using either stapled or hand-sewn techniques, with no significant differences in short-term outcomes.
Vaginal cuff closure in laparoscopic hysterectomy (TLH) was compared between polyglactin 910 suture and unidirectional barbed suture. In a study of 68 patients, vaginal cuff complications, postoperative vaginal bleeding, long term complications, and closure duration were estimated. Patients were divided into two groups - Group 1 used polyglactin 910 suture (n=44) and Group 2 used unidirectional barbed suture (n=24). Postoperative vaginal bleeding occurred in 32.5% of Group 1 and 18.8% of Group 2, showing a significant reduction with barbed suture. No other short or long term complications showed a significant difference between
Tips and Tricks in Laparoscopic Dissection of AdhesionsGeorge S. Ferzli
The document provides information on laparoscopic dissection of adhesions. It discusses the historical perspectives on adhesions, adhesion pathophysiology, prevention of adhesion formation, complications related to adhesions, results of laparoscopic adhesiolysis for small bowel obstruction, operating room set up, laparoscopic management indications and outcomes, laparoscopic approach, peritoneal access and potential trocar injury, optical access trocars, and recommended tools for adhesiolysis.
Surgical Management Of Diverticular DiseaseReda Hussein
This document summarizes the surgical management of diverticular disease based on a literature review. It describes different stages of diverticular abscesses and appropriate treatment approaches. For smaller abscesses, antibiotics or CT-guided drainage may be sufficient, while larger abscesses often require drainage followed by elective surgery. The document also discusses approaches to acute diverticulitis, obstruction, and fistulas, noting debates around conservative versus operative management.
ENDOSCOPIC TREATMENT OF PILONIDAL SINUS IN EGYPTIAN PATIENTSindexPub
Background: Treatment for pilonidal disease using minimally invasive methods is a reliable and successful alternative to conventional surgery, with quicker recovery, better cosmetic outcomes, and better pain management. The primary goals of this study are to assess the early outcomes of endoscopic pilonidal sinus treatment and to demonstrate the surgical approach and its adaptations. Materials and Methods: Our study was conducted on 30 patients with pilonidal sinus disease as a prospective cohort study for endoscopic treatment of the pilonidal sinus, from October 2021 to October 2022, in our surgical department at Theodor Bilharz Research Institute (TBRI). Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic, and patient satisfaction levels were assessed through a standardized phone interview. Results: There were 24 males and 6 females, with a median age of 21.87±1.85 years (ranging from 16 to 57 years). The mean operative time was 44.17 (35-55) ±1.26 min. During the follow-up period of 24 weeks, wound closure was seen after a median of 4 weeks. Wounds were closed in 72% of patients after one month and 93% of patients after two months. 2 patients had to be re-operated due to failure: one had persistence of discharge, and the other had recurrence after 3 months. The satisfaction rate was 93.3%. Conclusions: Endoscopic pilonidal sinus treatment is a minimally invasive and cosmetically favorable procedure. To find out if it reduces recovery time and the long-term recurrence rate, a larger sample size and a longer follow-up are needed.
Gossypibomas are foreign bodies that result from retained surgical sponges or packing materials. They most commonly occur after abdominal surgery and can cause complications like bowel obstruction if left in the body for many years. Diagnosis is difficult due to non-specific symptoms but can be aided by imaging like ultrasound, CT scans, or MRI scans which can detect the retained materials. Prevention efforts include careful sponge counting before and after surgery and use of radiofrequency tagged sponges to ensure none are accidentally left inside patients.
Laparoscopically assisted high ligation of patent processus vaginalis in children was evaluated in this study. The procedure was found to be a safe and effective day procedure for repairing inguinal hernias in children. It allowed for detection of contralateral hernias in 28% of cases without increasing operative time. Outcomes included a low recurrence rate of 2.5% and mean hospital stay of 4 hours. The technique of piecemeal ligation of the patent processus vaginalis externally was found to be simple with no need for additional ports or special instruments.
Efficacy of laparoscopically assisted high ligation of patent processus vagin...Hisham Ahmed,M.D,PhD,MRCS
Laparoscopically assisted high ligation of patent processus vaginalis in children was evaluated in this study. 40 patients underwent the procedure, which involved inserting trocars and using laparoscopy to identify and ligate the patent processus with sutures tied externally. The procedure had a low complication rate, short hospital stay, and detected unsuspected contralateral hernias in 28% of cases. At 18-month follow up, there was one recurrence with no other complications, demonstrating this technique is a safe and effective minimally invasive option for treating hernias in children.
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2018.parastomal hernias how to prevent...
1. A.Odobašić
University Clinical Center Tuzla - Bosnia and Herzegovina
Mediterranean Society of Coloproctology
XI Biennial Congress of the MSCP; Thessaloniki, Greece, May 4 - 5, 2018.
Parastomal hernias:
How to prevent, when and how to repair?
1
2. Conflict of interest
Author declare that this lecture has not been published in
whole or in part elsewhere; the manuscript is not currently
being considered for publication in any another journal;
Author has been personally and actively involved in
substantive work leading to the manuscript, and will hold
themselves responsible for its content. Author declare that he
has no conflict of interest.
2
10. Incidence of PSH
•The true incidence of PSH is difficult to assess
and varies widely depending on:
•the length of follow-up
•the type of ostomy...
•Loop colostomy - 0 to 30,8%
•End colostomy – 0 to 48,1%
•Loop ileostomy – 0 to 6,2%
•End ileostomy – 1,8 to 28,3%
10
11. Risk factors for PSH formation
•Smoking
•Obesity
•Diabetes
•Malnutrition
•Immunosuppression
•Patients with conditions that chronically increase
intra-abdominal pressure, including cough and
COPD
•Advanced liver disease with ascites...
11
16. European Hernia Society classification of parastomal
hernias
M. Smietanski • M. Szczepkowski • J. A. Alexandre • D. Berger •K. Bury • J. Conze • B.
Hansson • A. Janes • M. Miserez • V. Mandala•Montgomery • S. Morales Conde • F.
Muysoms
Hernia (2014) 18:1–6
The classification proposal is based on the PSH defect size (small
is 5 cm) and the presence of a concomitant incisional hernia
(cIH). Four types were defined:
• Type I, small PSH without cIH;
• Type II, small PSH with cIH;
• Type III, large PSH without cIH;
• Type IV, large PSH with cIH.
16
17. Surgical treatment of PSH
Simple Fascial Repair - high recurrence rates ranging
from 10 to 76%
Stoma Translocation - with recurrence rates of 33% to
76%
Mesh repair – recurrence rates less than 20% for both
synthetic and biologic meshes
Onlay mesh placement, retromuscular mesh placement,
open intraperitoneal mesh placement with either the
keyhole or Sugarbaker technique
Laparoscopic mesh placement – Keyhole technique,
Sugarbaker, Sandwich technique....
17
23. Dr. Berger’s Sandwich technique for mesh fixation. (A) The fixation of the first mesh. This
technique is similar to Keyhole technique; (B) the fixation of the second mesh. The lower
edge can be pulled into the anterior gap of the bladder and fixed to the pubic arcuate
ligament; (C) the fixation of the second mesh. The mesh covers the lateral bowel loop (5–10
cm). The technique is similar to Sugarbaker technique.
23
24. Surgical techniques for parastomal hernia repair: a systematic
review of the literature
• BME Hansson et al. Annals of Surgery, 2012
• Primary outcome was recurrence after at least 1-year follow-up.
Secondary outcomes were mortality and postoperative morbidity.
• Thirty studies were included with the majority retrospective. Suture
repair resulted in a significantly increased recurrence rate when
compared with mesh repair (odds ratio [OR] 8.9, 95% confidence
interval [CI] 5.2-15.1; P < 0.0001). Recurrence rates for mesh repair
ranged from 6.9% to 17% and did not differ significantly. In the
laparoscopic repair group, the Sugarbaker technique had less
recurrences than the keyhole technique (OR 2.3, 95% CI 1.2-4.6; P =
0.016).
• The use of mesh in parastomal hernia repair significantly reduces
recurrence rates and is safe with a low overall rate of mesh infection.
24
25. Prophylactic mesh use during primary stoma formation
to prevent parastomal hernia
B Cornille, S Pathak, IR Daniels, NJ Smart Royal Devon and Exeter NHS Foundation
Trust, UK. Ann R Coll Surg Engl 2017; 99: 2–11
• METHODS A systematic search was performed using PubMed,
Embase™ and the Cochrane Library to identify randomised controlled
trials that analysed placement of prophylactic mesh versus no mesh
at time of initial surgery. Meta-analysis was performed using random
effects methods.
• RESULTS A total of 506 studies were identified by our search strategy.
Of these, 8 studies were included, involving 430 patients (217 mesh
vs 213 no mesh). Prophylactic mesh placement resulted in a
significantly lower rate of PSH formation (42/217 [19.4%] vs 92/213
[43.2%]) with a combined risk ratio of 0.40 (95% confidence interval
[CI]: 0.21–0.75, p=0.004). Placement of prophylactic mesh did not
result in increased peristomal complications (15/218 [6.9%] vs
16/227 [7.0%]) with a combined risk ratio of 1.0 (95% CI: 0.49–2.01,
p=0.990).
25
26. • CONCLUSIONS Prophylactic placement of mesh at primary
stoma formation may reduce the incidence of PSH, without
an increase in peristomal complications.
• However, the overall quality of the randomised controlled
trials included in the meta-analysis was poor, and should
prompt caution regarding the applicability of the findings of
the individual studies and the meta-analysis to every-day
practice.
26
28. StMesh stomA Reinforcement Technique (SMART) in the prevention of
parastomal hernia: a single-centre experience
Z. Q. Ng, P. Tan, M. Theophilus, Hernia June 2017, Volume 21, Issue 3, pp 469–475
• The aim of this retrospective analysis was to evaluate the outcomes of
Stapled Mesh stomA Reinforcement Technique (SMART) in terms of
parastomal hernia occurrence rate and mesh-related complications.
• METHODS All patients operated with an abdominal perineal resection
or Hartmann’s procedure with SMART from November 2013 to March
2016 were included. Patient demographics, operative details and stoma-
related symptoms were collected. Patients were examined clinically by
the medical team and also reviewed independently by a specialist stoma
care nurse for signs of stoma-related complications. As part of
oncological follow-up, CT scans were available for review for evidence of
parastomal herniation.
28
29. • RESULTS 14 patients (mean age 76 years) were included in the
analysis. All the SMART cases were successfully completed with no
intraoperative or immediate post-operative complications.
• No cases of mesh-related complications such as infection,
immediate stomal prolapse, stenosis, retraction, stomal
obstruction, mesh erosion or fistulation were observed. No mesh
removal was required.
• There were two cases of parastomal hernia detected on CT scan.
Both cases have remained asymptomatic no intervention was
required at this stage. Median follow-up was 24 months.
• CONCLUSION Our medium-term experience has demonstrated
the efficacy of SMART in the reduction of parastomal hernia
occurrence. With appropriate learning curve, parastomal hernia
can be prevented.
29
31. Preventing parastomal hernias with systematic
intraperitoneal specifically designed mesh
• Raquel Conde-Muíño, José-luis Díez, Alberto Martínez, Francisco Huertas,
Inmaculada Segura and Pablo PalmaB . BMC SURGERY 2017, 17:41
• METHODS Data were prospectively recorded. A specifically
designed mesh made of polyvinyl fluoride with central conduit
(Dynamesh IPST®) was fixed using an intra-peritoneal onlay
technique. Safety was evaluated by means of surgical data and
frequency of mesh-related complications, efficacy by the rate
of parastomal hernias.
31
32. • RESULTS Thirty-four patients were included in the study. Three
of them died before a year of follow up (not related to the
stoma), so they were excluded. The other 31 patients (11
women and 20 men) were prospectively followed up after
different pathologies resulting in a permanent colostomy.
Twelve months after surgery CT-Scan imaging revealed two
(6.4%) parastomal hernias, one of them already clinically
suspected. During the follow up, 29% of the patients (n = 9)
developed another type of hernia (incisional, inguinal or both).
In five patients (16.1%) a light stomal retraction of the
otherwise slightly prominent ostomy was observed. Median
clinical follow-up was 17.5 months (range 12–34).
• CONCLUSIONS Prophylactic parastomal mesh placement might
be a safe and effective procedure with a potential to reduce the
risk of parastomal hernia. Routine use of this technique should
be further analysed.
32
34. Prophylactic Mesh Placement During Formation of an
Endcolostomy Reduces the Rate of Parastomal Hernia
Short-term Results of the Dutch PREVENT-Trial
Henk-Thijs Brandsma, Birgitta M. E. Hansson, Theo J. Aufenacker, Dick van Geldere,
Felix M. V. Lammeren, Chander Mahabier, Peter Makai.
Annals of Surgery. 2017;265(4):663-669.
METHODS: Augmentation of the abdominal wall with a retro-
muscular lightweight polypropylene mesh was compared with
the traditional formation of a colostomy. In total, 150 patients
were included. The incidence of a PSH, morbidity, mortality,
quality of life, and cost-effectiveness was measured after 1 year
of follow-up.
34
35. • RESULTS: There was no difference between groups regarding
demographics and predisposing factors for PSH. Three out of
67 patients (4.5%) in the mesh group and 16 out of 66
patients (24.2%) in the nonmesh group developed a PSH (P =
0.0011).
• CONCLUSION: Prophylactic augmentation of the abdominal
wall with a retromuscular lightweight polypropylene mesh at
the ostomy site significantly reduces the incidence of PSH
without a significant difference in morbidity, mortality,
quality of life, or cost-effectiveness.
35
37. European Hernia Society guidelines on prevention and treatment of
parastomal hernias
S. A. Antoniou · F. Agresta · J. M. Garcia Alamino · D. Berger · F.
Berrevoet · H.-T. Brandsma · K. Bury · J. Conze · D. Cuccurullo · U. A.
Dietz · R. H. Fortelny · C. Frei-Lanter · B. Hansson · F. Helgstrand · A.
Hotouras · A. Jänes · L. F. Kroese · J. R. Lambrecht · I. Kyle-Leinhase ·
M. Lopez-Cano · L. Maggiori · V. Mandalŕ · M. Miserez · A.
Montgomery · S. Morales-Conde · M. Prudhomme · T. Rautio · N.
Smart · M. Śmietański · M. Szczepkowski · C. Stabilini · F. E. Muysoms
• Hernia (2018) 22:183–198
• Background International guidelines on the prevention and
treatment of parastomal hernias are lacking. The European Hernia
Society therefore implemented a Clinical Practice Guideline
development project.
• Methods The guidelines development group consisted of general,
hernia and colorectal surgeons, a biostatistician and a biologist,
from 14 European countries.
37
38. RESULTS End colostomy is associated with a higher incidence of parastomal
hernia, compared to other types of stomas. Clinical examination is
necessary for the diagnosis of parastomal hernia, whereas computed
tomography scan or ultrasonography may be performed in cases of
diagnostic uncertainty.
Currently available classifications are not validated; however, we suggest
the use of the European Hernia Society classification for uniform research
reporting. There is insufficient evidence on the policy of watchful waiting,
the route and location of stoma construction, and the size of the aperture.
The use of a prophylactic synthetic non-absorbable mesh upon
construction of an end colostomy is strongly recommended.
So far, there is no sufficient comparative evidence on specific techniques,
open or laparoscopic surgery and specific mesh types. However, a mesh
without a hole is suggested in preference to a keyhole mesh when
laparoscopic repair is performed.
CONCLUSION An evidence-based approach to the diagnosis and
management of parastomal hernias reveals the lack of evidence on several
topics, which need to be addressed by multicenter trials. Parastomal hernia
prevention using a prophylactic mesh for end colostomies reduces
parastomal herniation. Clinical outcomes should be audited and adverse
events must be reported. 38
39. •With such a high incidence of PSH and recent success
with mesh repair, much attention has been given to
prophylactic mesh placement at the time of primary
stoma formation.
•Parastomal hernia prevention using a prophylactic mesh
for end colostomies reduces parastomal herniation
•Various techniques can be compared only through
prospective randomized controlled trials (RTCs).
•Hernia prevention with prophylactic mesh placement at
the time of stoma creation may be the continued focus
of future research.
39
These are familiar terms to all of us. Some colleagues underestimate this problem.
I, and probably You as well, come across this problem very often in our everyday practice.
There are different types of intestinal ostomies.
Temporary ostomy - is an ostomy that can be removed surgically at a later time.
Permanent ostomy - is an ostomy that is used when parts of the rectum, anus and colon have been removed due to disease or treatment of a disease.
An ostomy may be constructed as an end ostomy or a loop ostomy, depending on the specific circumstances for which an ostomy is being created.
End ostomy - A stoma is created from one end of the bowel. Proximal end forms stoma, and distal end is removed or sewn closed.
Loop ostomy – This type of ostomy is usually used in emergencies and is a temporary or permanent. Loop of bowel is exteriorized, opened and sewn to the skin.
Double Barrel ostomy – Bowel is surgicaly cut, and both ends are brought through the abdomen.
I believe everyone here knows how to make stoma, whatever kind it was: TEMPORARY or PERMANENT, END, LOOP or DOUBLE BARELL, ILEOSTOMY or COLOSTOMY.
Our todays topic will be PERMANENT END COLOSTOMY
And most often complication of these procedure – PARASTOMAL HERNIA
Parastomal hernia is a protrusion of abdominal contents through a weakness in the abdominal wall at the site of the previous hole made for delivering the stoma.
Is really Parastomal hernia – the Achilles Heel of a Permanent Colostomy?
The incidence of parastomal hernia is between 0 to 48.1 per cent, even biger, depending on the type of stoma and length of follow-up.
The highest incidence is an end colostomy.
There are many risk factors for PSH formation
Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty.
..... And CT SCAN
There are several classifications of PSH.
In practice is often used,very simple, Devlin classification – 4 types. Type 1 – interstitial; Type 2 – subcutaneus; Type 3 – intrastomal; Type 4 – peristomal (stomal prolaps)
!!!! The current clasification – from European Hernia Society – is based on the PH defect size (5cm) and the presence of concomitant incisional hernia..
Subclasses of classification were defined as follows:
Type I: PH to 5 cm without cIH.
Type II: PH to 5 cm with cIH.
Type III: PH larger than 5 cm without cIH.
Type IV: PH larger than 5 cm with cIH.
P: primary PH.
R: recurrence after previous PH treatment.
When it comes to PSH, we need to decide which type of surgical treatment should be done.
NO MESH REPAIRS, such as SIMPLE FASCIAL REPAIR AND STOMA TRANSLOCATION, have HIGH RECURRENCE RATES.
However, todays treatment of parastomal hernia is impossible without using a mesh. It is only a question of what type of mesh should be used (synthetic or biological), shape of mesh, and position of mesh.
Surgical treatment can be open (Open mesh placement) and laparoscopic (Laparoscopic mesh placement ).
A - Depiction of the Sugarbaker repair. Inset depicts axial view of lateralized bowel traversing abdominal wall with mesh placement relative to bowel and abdominal wall.
B - Postoperative CT scan showing axial view of lateralized bowel traversing the abdominal wall. Note the lateral most portion of bowel as it enters between the biologic mesh and the anterior abdominal wall. Contrast flows freely indicating lack of obstruction.
We see a schematic depiction of Sugarbaker repair and insert with laparoscopic Sugarbaker repair.
Depiction of the “Keyhole” repair. Inset depicts axial view of bowel traversing abdominal wall with mesh surrounding limb of stoma relative to bowel and abdominal wall.
We see a schematic depiction of the “Keyhole” repair and insert with laparoscopic Keyhole repair.
So called Sandwich technique. The Sandwich technique represents a combination of the Keyhole and Sugarbaker techniques.
!!! Question is- Should we do these surgeries before PSH is formed or after PSH is formed? How to prevent PSH, when and how to repair?
Let see what literature has to say.
This systematic review aimed to evaluate and compare the safety and effectiveness of the surgical techniques available for parastomal hernia repair.
Thirty studies were included. Suture repair resulted in a significantly increased recurrence rate when compared with mesh repair.
In the laparoscopic repair group, the Sugarbaker technique had less recurrences than the keyhole technique.
A systematic search was performed using PubMed, Embase™ and the Cochrane Library to identify randomised controlled trials that analysed placement of prophylactic mesh versus no mesh at time of initial surgery.
A total of 506 studies were identified by search strategy. Of these, 8 studies were included, involving 430 patients (217 mesh vs 213 no mesh).
Prophylactic mesh placement resulted in a significantly lower rate of PSH formation 19.4% vs 43.2%.
Prophylactic placement of mesh at primary stoma formation may reduce the incidence of PSH, without an increase in peristomal complications.
I cant talk to much about so called SMART method. Stapled Mesh stomA Reinforcement Technique (SMART) I have done it only two times as a prevention of PSH. There was no recurrence in these two years since I have done them. The method itself is very simple and elegant.
In this retrospective analysis was to evaluate results outcomes of SMART in the prevention of PSH.
In one center during tree years was analysis 14 patients wich operated with an abdominal perineal resection or Hartmann’s procedure.
All 14 cases were successfully completed with no intraoperative or immediate post-operative complications.
There were 2 cases of parastomal hernia detected on CT scan. Median follow-up was 24 months.
One more very interesting method. Specifically designed mesh with intraperitoneal position.
In this study is used specificially designed mesh. This mesh made of polyvinyl fluoride with central conduit was fixed using an intra-peritoneal onlay technique.
Thirty-four patients were included in the study. Three of them died before a year of follow up (not related to the stoma), so they were excluded.
The other 31 patients were prospectively followed up after different pathologies resulting in a permanent colostomy.
Twelve months after surgery CT-Scan imaging revealed two (6.4%) parastomal hernias.
Median follow up was 17,5 months.
Authors of this research concluded - Prophylactic parastomal mesh placement might be a safe and effective procedure.
A very simple method followed. The mesh is placed in the retromuscular plane on the posterior rectus sheath/peritoneum. The bowel is passed through the pre-shaped cruciate hole in the mesh and the rectus muscle.
The aim of this study was to investigate the incidence of parastomal hernias after end-colostomy formation using a polypropylene mesh (retromuscular position) in a randomized controlled trial versus conventional colostomy formation. In total, 150 patients during 3 years were included.
Patients were recruited from 11 teaching hospitals and 3 university centers in the Netherlands. Follow up was 1 year.
4.5% in the mesh group and 24.2% in the nonmesh group developed a PSH.
Authors concluded - Prophylactic augmentation of the abdominal wall with a retromuscular lightweight polypropylene mesh at the ostomy site significantly reduces the incidence of PSH.
This year in journal Hernia, European Hernia Society published Guidelines on prevention and treatment of parastomal hernias.
This guidelines development group consisted of general-, colorectal-, hernia surgeons, a biostatisticians and a biologists, from14 European countries.
However, one of the important conclusions of these guidelines is the high-quality evidence which supports the use of a prophylactic mesh during construction of a permanent end colostomy.
So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types.