Reprint of: Parastomal hernia: Surgical management

Parastomal hernia is a common clinical problem that is difficult to manage. Although surgical repair is recommended for the majority of other incisional hernias to prevent the complications of incarceration, obstruction, or strangulation, most authors recommend nonoperative management of parastomal hernias. Surgical management is usually reserved for those patients whose parastomal hernia results in intractable difficulty maintaining an effective stoma appliance or who develop a severe complication. This article reviews the nonoperative and operative management of parastomal hernias by fascial repair and stomal relocation. Unfortunately, no randomized trials exist to guide the surgeon in the choice between the accepted nonoperative and surgical management options. Fascial repair without a prosthetic should probably be used only in the rarest of circumstances. If stoma relocation is selected, the stoma should be relocated to the opposite side of the abdominal wall and reconstructed using techniques associated with the lowest risk of stoma-related complications and parastomal hernia. However, the best outcomes may require the use of a prosthetic either to either repair or prevent a parastomal hernia.     

Reprint of: Management of fecal incontinence: Surgical treatement

Fecal incontinence is not a rare condition. In the majority of patients, no operative means result in symptom relief. Only if these fail surgical intervention is indicated. Various new surgical options have evolved over the last decades. The evidence of their efficacy varies substantially. The mainstays of surgical treatment of fecal incontinence are sphincteroplasty and sacral nerve stimulation. Data of other techniques, like posterior tibial nerve stimulation, radiofrequency energy delivery and bulking agents, are less robust. The article aims to outline the currently commonly accepted and frequently applied surgical techniques for treatment of fecal incontinence and their results and to present novel techniques, which carry potential for the future.     

Choledochal cysts: Part 3 of 3: Management

Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 3, we discuss the management of choledochal cysts, thus completing our comprehensive review.     

Choledochal cysts: Part 2 of 3: Diagnosis

Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 2, we explore the details surrounding diagnosis, describing the presentation and imaging of the disease.