Parastomal hernia repair
Primary fascial repair
[edit | edit source]- Peristomal curved incision (outside the base plate to avoid getting in the way, about 1/3 to 1/2 the diameter)
- Dissect onto the sac, and dissect it to the level of fascia
- May be necessary/helpful to open the sac
- Resect sac
- Close fascia with interrupted permanent suture
- Onlay mesh if there is no contamination
- Close dead space as much as possible (often get a depression from reduced fat around the stoma, which can make it hard to fit the stoma)
- Close skin and reapply bag
Intra-abdominal (can be open, laparoscopic or robotic)
[edit | edit source]- Enter abdomen away from stoma
- Adhesiolysis
- Reduce parastomal hernia
- Resect sac
- Close defect
- Primary closure with laparoscopic sutures/trans-fascial sutures
- Mesh with hole
- Sugarbaker repair - laterally-orientated groove in mesh to add dog-leg
- Close abdomen