Clinical Analysis Of22Patients With Parastomal Hernia After Miles Operation

Objective: To study the causes of Miles parastomal hernia and respective advantages ofopen and laparoscopic operation in the treatment of parastomal hernia.Methods: This study consisted of22patients who underwent in site parastomal herniaafter rectal carcinoma in the Department of general surgery of the Second AffiliatedHospital of Dalian Medical University from January2008to January2013.Clinical datawere collected, including6males and16females who are52-74years old(the averageage is63.17years old).The onset time of the parastomal hernia was7-57months afteroperation(the average was23months).The site of stoma is through the left rectusabdominis in7cases (31.82%), and through the left lateral rectus abdominis in15cases.The BMI is≥25kg/m2with8patients and15cases are with underlying diseases(68.18%). Clinical manifestations: abdominal mass were found in22cases (100%),abdominal pain is in18cases(81.82%), stoma closed bad in12cases(54.55%),stomaobstruction is in6cases(27.28%)and strangulated and impacted is in2cases (9.09%).Hernia ring axis is4-8cm(the average is6cm). Without the operation taboos, and CTand ultrasound examination can prove parastomy defect of abdominal wall,we start theoperation treatment with the indication including2cases of emergency operation and20cases of selective operation.Open abdominal tension-free parastomal hernia repair is in16cases and laparoscopic repair is in6cases with CK Parastomal stoma (side) herniaspecial patch of the United States Budd Company.And After the operation,we use theantiboitics to prevent infection,and with the gastrointestinal decompression, fluidreplacement and regular dressing treatment.Results:With the heavy adhension of1patient,we finally convent the open operation.The laparoscopic operation is in5patients with65-190min(the average time is105min)and open operation is in17patients with80-210min(the average time is135min).Postoperative complications: in the laparoscopic operation group,abdominaldistension was found in1case(20%), serous tumor of patch and the inter-abdominal wall is in2cases(40%)and the chronic pain in3cases (60%). In the open operationgroup,abdominal distension was found in8case(47.06%), serous tumor of patch and theinter-abdominal wall in9cases(52.94%),the chronic pain in14cases (82.35%) andincision liquefaction in4cases (23.53%).Due to extensive tumor metastasis,4casesdied and1cases lost follow-up.17patients were followed up and no one recurred.Conclusion:1The causes of parastomal hernia is multiple factors, and the pathogenesisis complicated;2Laparoscopic operation for the treatment of parastomal hernia has theadvantages including short operation time, less trauma, quicker recovery and lesspostoperative complications;3Open and laparoscopic operation make no significantdifference with the recurrence rate of the operation.