High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study.
AIM
This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction.


METHOD
We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up.


RESULTS
Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m2 (range 25-47). Twelve patients had an expected associated risk according to the Carolinas equation for determining associated risk classification of >60%. Sixty per cent of our patients had contaminated or dirty/infected wounds. The overall complication rate was 60%. Surgical site infection was observed in 25% of the cases. The mortality rate in our study group was 5% (n = 1). We found clinical or radiological evidence of parastomal hernia recurrence in nine out of 20 (45%) patients during follow-up. No hernia recurrence was detected in the concomitant incisional hernias.


CONCLUSIONS
Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.
['Robin Valle de Lersundi|Alvaro|A|https://orcid.org/0000-0002-4129-643X', 'Rupealta|Niccolo|N|https://orcid.org/0000-0003-2844-3316', 'San Miguel Mendez|Carlos|C|', 'Muñoz Rodriguez|Joaquin|J|', 'Pérez Flecha|Marina|M|', 'López Monclús|Javier|J|', 'Blazquez Hernando|Luis|L|', 'García Ureña|Miguel Angel|MA|']
D000009:Abdominal Muscles D006555:Hernia, Ventral D059685:Herniorrhaphy D006801:Humans D000069290:Incisional Hernia D012008:Recurrence D012189:Retrospective Studies D013526:Surgical Mesh D016896:Treatment Outcome
Posterior components separation transversus abdominis release complex para-stomal hernia key-hole mesh repair