Symptomatic Parastomal Hernia
- Reduction of the hernia contents.
- Excision of the hernia sac.
- Tension-free closure of the fascial defect (if possible).
- Possible mesh reinforcement.
- Mesh placement, in a retrorectus or intraperitoneal underlay position, reduces recurrence rates. In emergent or contaminated cases, suture repair alone with or without absorbable/biologic mesh placement may be the preferred option.
- A keyhole mesh can be fashioned, allowing passage of the stoma conduit through the mesh.
- Alternatively, a modified Sugarbaker-type biologic mesh repair can be used, where the ostomy is lateralized using a non-circumferentially secured underlay mesh.
