Laparoscopic repair of parastomal hernias: a multi-centre retrospective review and shift in technique

Purpose : To describe the reasons for a shift in our technique of laparoscopic repair of parastomal hernias towards repair with a non-slit mesh. Our initial results with repair using meshes with a keyhole had high recurrence rates. Methods : We performed a multi-centre retrospective study focusing on complications and recurrences. Data were gathered retrospectively from the medical records. The last follow-up date was the latest clinical examination by the surgeon. Recurrences were diagnosed clinically or by CT scan performed for oncological follow-up in cancer patients. Results : From September 2001 till May 2007, twenty-four patients with a symptomatic parastomal hernia were treated laparoscopically. No major intra- or postoperative complications were encountered. We had no conversions, no enterotomies and the overall postoperative morbidity was 8.4% (2/24). During a mean follow-up of 21.2 months, ten recurrences or 41.7% (10/24) have been diagnosed. In patients treated with a "keyhole technique" recurrence rate was 72.7% (8/11) with a mean follow-up of 30.7 months. In patients treated with a "modified Sugarbaker technique" recurrence rate was 15.4% (2/13) with a mean follow-up of 14.0 months. Conclusions : We found laparoscopic parastomal hernia repair could be performed with few complications. We abandoned the "keyhole techniques" because of a high recurrence rate. We currently use a "modified Sugarbaker technique" with promising early results