Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | luni, 21 ianuarie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
English
British Flag| Romana Romanian Flag
 
Creditare EMC
Colegiul Medicilor
Va invitam sa va inregistrati/abonati la Jurnalul de chirurgie pentru a beneficia de creditare EMC
User

Parola

Tine minte
Ti-ai uitat parola?
Syndicate

Advertisement

Elmed

Estima

Liamed

Listare E-mail

POT FI PREVENITE EVENTRAȚIILE PARASTOMALE?
E. Târcoveanu, Elena Cotea, A. Vasilescu, Cr. Lupașcu,
N. Dănilă, N. Vlad, Delia Rusu
Clinica I Chirurgie I. Tănăsescu – Vl. Buțureanu,
Universitatea de Medicină și Farmacie Gr. T. Popa Iași
Jurnalul de chirurgie 2011; 7 (1): 123-129
Presentation:
Format PDF (Română/Romanian)

Abstract:

Parastomal hernias, although rarely encountered, make special therapeutic problems. The increase in incidence is related to increased life expectancy of patients with rectal cancer. In First Surgical Clinic, between 1993 to 2010 were treated 1465 incisional hernias, of which there were 37 parastomal hernias at 28 patients (2.5%), 9 of which are recurrent parastomal hernia. Clinical examination, intraoperative exploration and CT exam stated the following subtypes of parastomal hernia: interstitial (sac within layers of the abdominal wall) - 10 cases; subcutaneous (hernia sac in the subcutaneous plane) - 12 cases; intrastomal (sac penetrates into stomy) - 7 cases; peristomal (sac is within prolapsing stoma) – 8 cases. Only in one case, parastomal hernia appeared after loop colostomy, the rest came after end colostomy. The most parastomal hernias were asymptomatic; only six cases with parastomal hernias required emergency surgical treatment for obstruction (3 cases) or strangulation (3 cases). Two patients had associated median incisional hernia. We performed: local tissue repair in 22 cases (8 cases with recurrent parastomal hernia; stoma relocation in one case); sublay mesh repair in 15 cases (one case with recurrent parastomal hernia; stoma relocation in 5 cases). Associated surgery were practiced: viscerolysis, colic resection (6 cases), small bowel resection (2 cases). Postoperative morbidity registered were 5 wound infections (one case after mesh repair which required surgical reintervention) and stoma necrosis in one case with strangulation parastomal hernia with severe postoperative evolution and death. After local tissue repair recurrences were seen in 7 cases, after mesh repair we registered recurrence only in one case, that helped a parietal suppuration and no relapse after the relocation of the stoma. Because the our study and literature review have demonstrated a mesh repair is a safe procedure in the treatment of parastomal hernia, in 2010 we have initiated a prospective prospective randomized trial where prophylactic use of mesh at the time of stoma formation to reduce the risk of parastomal hernia. We describe a surgical techniques sublay mesh placement. So far have been enrolled in the study 10 patients with mesh implanted at the primary operation and 12 patients no mesh. The inclusion criteria are: patients with lower rectal cancer, stage II-III, irradiated, obese, with a history of hernias, patients who do physical work. We use polypropylene mesh. The patients were followed for a median of 9 months (range 3 to 12 months) by clinical examination every 3 months. We registered 3 recurrences, all in the no mesh cohort. We have not seen any morbidity to patients from mesh group. The study will be completed in 2012 after they enroll at least 20 patients in each group and after longer follow up needed to confirm results. Conclusions: Parastomal hernia is a relatively rare disease reported in number of incisional hernia. With increasing life expectancy stands we noted and increased incidence of parastomal hernia. Prophylactic use of mesh during the primary operation is a safe procedure and reduces the risk of parastomal hernia.

KEY WORDS: PARASTOMAL HERNIA, MESH REPAIR, PROPHYLACTIC MESH

Correspondence to: Prof. Dr. Eugen Tarcoveanu, Clinica I Chirurgie, Spitalul Sf. Spiridon, Str. Independentei nr. 1, 700111, Iasi, e-mail:



: Creative Commons License
Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.