Is 3-D Fascial Reinforcement with "Silo" Technique the Answer for Complex Parastomal Hernia?
Vishwanath Chegireddy, M.D., Dmitry Zavlin, M.D., Warren Ellsworth, IV, M.D., Tue Dinh, M.D..
Houston Methodist Hospital, Houston, TX, USA.
PURPOSE: Parastomal hernia entails an enlargement of the original tunnel of the stoma through the abdominal wall muscle and fascia. The incidence of parastomal hernias ranges from 3% to 39%. Here, the authors describe their novel Silo technique for parastomal hernia repair which aims to increase the structural strength of the tunnel wall, reinforce the fascia above and below, and maintain a stable size of the stoma opening. The goal is to preserve the abdominal wall with in-situ repair, reduce recurrence by maintaining a stoma opening diameter of 2 to 3 cm with 3-dimensional fascial reinforcement, and reduce post-operative adhesions and infections with non-cross-linked porcine dermal matrix mesh. METHODS: We retrospectively analyzed twenty-three patients who underwent a parastomal hernia repair between January 2009 and June 2017 by our two senior authors using the Silo technique. Patient data extracted included demographic information, body mass index (BMI), past medical and surgical history, inpatient data, adverse outcomes, and follow-up. Primary outcome parameters were hernia recurrence, wound-related issues, and postoperative surgical complications. RESULTS: Twenty-three patients were identified: mean age was 65.5 years, 10 patients were male, 13 female, and average BMI was 30.4 kg/m2. A concomitant ventral hernia was repaired in 13 patients and 12 patients had 2 or more previous parastomal hernia repairs. Ostomy type consisted of 13 (54.2 %) colostomies, 6 (25 %) ileostomies, and 5 (20.8 %) urostomies. The average surgery lasted 324 min, and the average length of hospital stay was 7.6 days. Post-operatively, 4 patients had surgical site infections, 1 patient developed a seroma, and 1 patient experienced a wound healing delay. Readmissions encompassed 8 patients, 4 of which were due to small bowel obstruction (SBO). These 4 cases all necessitated reoperation, in addition to 1 reoperation for stoma retraction, and 1 for wound closure. Three patients were noted to have parastomal hernia recurrence during our average follow-up of 16.9 months. CONCLUSION: Based on our clinical outcomes, the Silo technique is associated with minimal complications and favorable recurrence rates and therefore represents a new and safe technique for complex parastomal hernias.
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