To summarize the therapeutic method and effectiveness of parastomal hernia repair in situ with sublay methods. Methods Between February 2003 and May 2009, 34 patients with parastoma hernia were treated with Sublay methods using primary midl ine incision approach and polypropylene patch. There were 23 males and 11 females withan average age of 58.4 years (range, 43-78 years). The disease duration was 1 to 17 years (mean, 4.7 years). Of 34 patients, 6 had recurrent parastoma hernia. The diameter of hernia ring was 5-12 cm (mean, 7.2 cm). Results Sublay technique repair was successfully performed in all patients. The operative time was 96-160 minutes (mean, 116 minutes). The gastric tube was pulled out 12 hours to 5 days (mean, 3 days) after operation. The drainage tube was taken out at 2-7 days (mean, 4 days) after operation. The postoperative hospital ization time was 7 to 15 days (mean, 9 days). And the incisions of 32 patients healed by first intention. Incisional fat l iquefaction occurred in 1 case and infection in 1 case, and their incisions healed after dressing change. Seroma at the upper of the patch occurred in 7 patients and was cured by 2 to 3 times of percutaneous puncture and local pressure. Thirty-two patients were followed up 6-75 months (mean, 32 months). No chronic pain, lumping sensation, or local expansion in wound area occurred. Two recurrences occurred 3 months and 7 months after operation, respectively, and patients restored after expectant treatment or re-operation. Conclusion The in situ Sublay methods using primary midl ine incision approach and nonabsorbable patch is a feasible and safe method for parastomal hernia repair.
Objective To investigate the procedure and the effectiveness of modified Sublay-Keyhole technique for repair in situ of parastomal hernia. Methods Between October 2007 and March 2010, 11 patients with parastomal hernia underwent modified Sublay-Keyhole technique for repair in situ. There were 5 males and 6 females with an average age of 63 years (range, 55-72 years). The average body mass index was 28.2 (range, 23.5-32.5). All stomas in patients were permanent, including 6 end colostomies caused by abdominal perineal resection for rectal cancer, 2 end ileostomies secondary to total colon resection for ulcerative colitis, and 3 end ileostomies following ileal conduit for bladder resection. One patient underwent previous prothetic repair with polypropylene mesh. The average time from last operation to admission was 2.5 years (range, 1-4.5 years). According to classification criteria of George Eliot hospital, 3 cases were classified as grade 2b, 2 as grade 3a, 5 as grade 3b, and 1 as grade 4. The average longest diameter of hernia ring was 9.5 cm (range, 6-12cm). Results Reconstructions of abdominal wall in all patients were performed successfully through modified Sublay-Keyhole technique. The average size of hernia ring was 75.5 cm2 (range, 30-112cm2), and the average size of polypropylene mesh was 280.5 cm2 (range, 175-360 cm2). The average operative time was 165 minutes (range, 120-195 minutes) and the average postoperative hospitalization days were 11 days (range, 9-14 days). All patients achieved healing of incision by first intention with no abdominal wall infection. Seroma and hematoma occurred in 2 patients and 1 patient, respectively, and were cured by needle aspiration and pressure bandaging. All patients were followed up 26.3 months on average (range, 10-39 months). One case suffered from parastomal hernia recurrence at 11 months postoperatively because of suture loosening and too wide aperture in mesh; and re-sutures in both mesh aperture and myofascial dehiscence were given and no recurrence was observed during additional follow-up of 15 months. No parastomal hernia recurrence or incisional hernia occurred in the other 10 patients.Conclusion Modified Sublay-Keyhole technique is an effective procedure for reconstruction of abdominal wall in patients with parastomal hernia for low recurrence incidence and less complications. But the long-term effectiveness needs further follow-up
Objective To compare the clinical effectiveness of different skin closure techniques in stoma reversal using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases were searched until February 1, 2021, and randomized controlled trials (RCTs) comparing outcomes between different skin closure techniques were included. Data were processed using Stata MP16.0 and R 3.6.1. Results The results demonstrated that 16 RCTs (n=2 139) were eligible for pooling. Six types of skin closure techniques were used: linear closure, purse-string closure, gunsight closure, linear closure and drainage, purse-string closure and drainage, and linear closure and biological mesh. Network meta-analysis indicated that the incidence of postoperative infection with linear closure was higher than that with purse-string closure [RR=6.04, 95%CI (3.11, 16.89), P<0.0001], gunsight closure [RR=10.75, 95%CI (1.12, 152.12), P=0.04], and linear closure and drainage [RR=3.18, 95%CI (1.24, 10.20), P=0.03]. The purse-string closure was superior to linear closure and biological mesh [RR=0.15, 95%CI (0.01, 0.88), P=0.03] in reducing postoperative infection. The length of hospital stay after linear suture was longer than that after linear suture and drainage [MD=1.16, 95%CI (0.29, 2.20), P=0.02]. Conclusions This network meta-analysis suggests that purse-string closure and gunsight closure might be best for reducing postoperative infection, and the addition of drainage could not further reduce the incidence of postoperative infection. In addition, implantation of the biological mesh does not increase the risk of postoperative infection. However, a large-scale RCT is warranted to confirm the results.
ObjectiveTo investigate the effects of health education pathway intervention on self-care agency and health lifestyle promotion in colostomy patients. MethodsEighty-eight rectal cancer patients who had undergone colostomy were randomly divided into control group and intervention group (with 44 patients in each) between March 2012 and September 2013. The control group received conventional nursing only, while the intervention group were given health education pathway intervention besides conventional nursing. The self-care agency and health lifestyle promotion in the two groups under pre-colostomy state, one week after colostomy and two weeks after colostomy were surveyed and compared based on the exercise of self-care agency scale and the health promotion lifestyle profile. ResultsAfter health education pathway intervention, the scores of self-care agency and health lifestyle promotion in the intervention group were significantly higher than those in the control group (P<0.05), and the hospitalization expenditure was also obviously lower. Furthermore, the satisfaction degree on nursing service was significantly higher than that of the control group (P<0.05). ConclusionThe health education pathway intervention can greatly improve self-care agency and quality of life in rectal cancer patients who have undergone colostomy.
Objective To summarize the surgical technique and the effectiveness of CK Parastomal patch in laparoscopic repair of parastomal hernia. Methods The cl inical data were retrospectively analysed from 24 patients who received laparoscopic repair of parastomal hernia using CK Parastomal patch between June 2006 and March 2010. There were 15 males and 9 females with a median age of 55 years (range, 47-80 years). Among them, 19 patients were with colon parastomalhernia in the left lower quadrant and 5 patients with ileum parastomal hernia in the right lower quadrant. The parastomal hernia duration was 1 to 4 years (mean, 2.4 years). The maximal diameter of the hernia ring was 3 to 7 cm (mean, 5.2 cm). All patients did not receive hernia repair. Results Laparoscopic repair of parastomal hernia was successfully performed in 18 cases, and open repair was used in 6 cases because of extensive adhesion. The average operating time was 121 minutes (range, 78 to 178 minutes). All wounds healed by first intention. Wound seroma occurred in 8 cases at 3 to 7 days after operation and disappeared by aspiration. Eleven patients complained of pain in the operative area within 1 month after operation and it disappeared without intervention. All patients were followed up 6 to 39 months (mean, 27 months). One recurrence occurred at 3 months after operation, and no recurrence occurred in the other patients. Conclusion Laparoscopic repair of parastomal hernia using CK Parastomal patch is a safe and feasible procedure with a satisfactory short-term effectiveness, but the long-term effectiveness should be further observed.
Objective To investigate the risk factors associated with the formation of parastomal hernia after Miles operation, and to provide scientific evidence for the prevention of parastomal hernia. Methods The clinical data of 218 patients with rectal cancer who undergoing Miles operation in the Affiliated Hospital of Xuzhou Medical University between May 2011 and May 2015 were analyzed retrospectively. Fifteen possible factors affecting the occurrence of parastomal hernia were selected. The fifteen related factors were analyzed by single factor analysis and two elements logistic regression analysis. Results A total of 55 patients with parostomy hernia occurred in 218 patients during follow-up period, and the incidence of parastomal hernia was 25.23%. Univariate analysis showed that age, thickness of subcutaneous fat in abdomen, BMI, stoma pathway, and hypertension were related to the formation of parastomal hernia after Miles operation (P<0.05). Further two elements logistic regression analysis showed that, advanced age, thickness of subcutaneous fat in abdomen, BMI>25 kg/m2, and transperitoneal were independent risk factors for the formation of parastomal hernia after Miles operation (P<0.05). Conclusion For patients with risk factors, it is very important to choose optimum stoma pathway during Miles operation to avoid the occurrence of formation of parastomal hernia after Miles operation.
ObjectiveTo investigate the technique and early results of hybrid repair of parastomal hernia with the DynaMesh-IPST. MethodsA retrospective analysis was made on the clinical data of 28 patients who underwent DynaMesh-IPST hybrid repair of parastomal hernia between October 2013 and June 2016. There were 18 males and 10 females, aged 49-84 years (mean, 71 years). The disease duration of parastomal hernia was 6-60 months (mean, 27.6 months). The body mass index (BMI) was 17-35 (mean, 25.6); there were 15 obese patients (BMI > 26). ResultsThe operation was completed smoothly in all patients. The mean stoma diameter was 6 cm (range, 4-9 cm). The mean operation time was 142 minutes (range, 110-190 minutes). The mean hospital stay was 9 days (range, 7-12 days). Seroma was found in 2 patients, and was cured by needle aspiration and pressure bandage. All 28 cases were followed up 1-33 months (mean, 19 months). No recurrence, infection, intestinal fistula, and stoma-related problems were found. The appearance of abdominal wall was symmetrical. ConclusionDynaMesh-IPST hybrid repair is a safe and feasible method for parastomal hernia, and the short-term operative result is satisfactory.