Paraostomy hernias: Prevention and prosthetic mesh repair

Abstract

Paraostomy hernias are frequent, occurring in 10-25% of patients in whom ostomy construction is required. The hernia may be a sliding type with migration of a portion of bowel proximal to the ostomy into the subcutaneous pocket. In other patients, the defect will contain omentum and numerous loops of adjacent small bowel; this type of hernia may become very large over time. Circumferential suturing of the lateral aspect of the intestinal segment to the posterior rectus sheath at the time of ostomy construction will prevent paraostomy hernia formation in most patients. If a hernia occurs, repair is best achieved using the technique of an "inverted pocket" with mesh leading the bowel out the lateral aspect of the paracolic sulcus. Data has confirmed that preperitoneal mesh application as a pocket repair is superior to a repair using the "keyhole technique". The optimal prosthetic mesh material for the pocket repair has not yet been established.