Laparoscopic Parastomal and Incisional Hernias

Laparoscopic hernia repair is a new, less-invasive, and safer procedure that may be used for incisional hernias and parastomal hernias. The procedure is another alternative for ostomy patients with colostomies, ileostomies or urostomies. It consists of three punctured openings done on the abdomen, one for the scope (to view) and the other two for the instruments (to operate on the hernia).

Laparoscopic Incisional Hernia

During a laparoscopic incisional hernia repair, the hernial sac is pushed inside the abdominal cavity. The defect stays open but it is covered with a permanent mesh graft placed under the abdominal muscles. Laparoscopic incisional hernia repairs have fast recovery (two-three days) because there is no incision of the abdominal wall. In the open procedure there is re-incision which bears considerable trauma and requires nursing of a large wound. Esthetically, the laparoscopic procedure goes almost unnoticed.

Laparoscopic Parastomal Hernia

There are two types of laparoscopic parastomal techniques:”keyhole” and “sugarbaker”. In keyhole repairs, the parastomal hernia is fixed with an intraperitoneal (inside the abdominal wall) mesh having an opening to allow the intestine through. In “sugarbaker” or “modified sugarbaker” repairs, the mesh is placed intraperitoneally as well but without the opening. The mesh covers the entire defect and surroundings of the intestine.

After repair, the instruments are taken away and the incisions sutured. In a follow-up appointment the surgeon removes the sutures and may place butterfly stitches, thin adhesive strips that hold the edges of the wound together as a Band-Aid.

As with the open procedure, incisional hernias and parastomal hernias have a propensity to re-occur. It is advisable to wear an ostomy support or an ostomy hernia belt on a daily basis for prevention purposes.

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