Parastomal hernia repair using the lateral approach

OBJECTIVE: To review the results of repairing a parastomal hernia after ileal conduit formation, using the lateral approach. PATIENTS AND METHODS: We retrospectively assessed 18 patients (9%) who developed a parastomal hernia, from 211 who had an ileal conduit created between 1982 and 2001; 15 had a surgical repair using a lateral incision. RESULTS: All 15 patients resumed a normal diet 1 day after surgery; the median (range) hospital stay was 4 (2-14) days. In two patients with a large hernia and difficult repair the stomas became ischaemic and required refashioning. Only one of these two patients required complete conduit replacement. The median (range) follow-up was 15 (1-72) months. A recurrence of the hernia was recorded in one grossly overweight patient. CONCLUSION: The lateral approach obviates the need for laparotomy and stomal relocation, and enhances a quick return of bowel function and early recovery. However, extra care is needed in managing the very large and difficult hernia, to avoid compromising the ileal conduit. The success and complication rates of the current series are within acceptable limits and this technique can be included in the options for managing parastomal hernia.