mansur_jagudin » 02 фев 2017, 19:05
Yuri W. Novitsky
Editor
Hernia Surgery
Current Principles. шпрингер 2016. Страница 176-178 Pauli Parastomal Hernia
Repair (PPHR)
This novel method of open parastomal hernia repair
avoids ostomy relocation, obviates the need to alter the mesh with either a cruciate or keyhole incision,
and permits simultaneous coverage of parastomal
and midline defects. This is achieved by combining
posterior component separation and TAR with a
modifi ed Sugarbaker mesh confi guration (essentially
a retro-muscular Sugarbaker herniorraphy).The initial steps of the PPHR are completed as
outlined above in the “Posterior Component
Separation” section. Here, however, the TAR is
carefully completed while maintaining the stoma
in situ (Fig. 17.10 ). With the retromuscular dissec-tion extended well beyond the boundaries of the
parastomal hernia in all directions, the defect in the
posterior layer (through which the stoma exits the
abdominal cavity) is intentionally extended laterally
(Fig. 17.11 ). On the contralateral site, retrorectus
dissection (or TAR, if needed) is completed.
The bowel proximal to the stoma is then delivered
into the retromuscular space. The posterior layer is
subsequently closed with running absorbable
suture simultaneously recreating the visceral sac
and lateralizing the location where the proximal
bowel enters the retromuscular space (Fig. 17.12 ).
Mesh is placed in a sublay position within the
retromuscular plane with a lateral confi guration
resembling a Sugarbaker repair. Transfacial
sutures are placed in all cardinal directions and
on either side of the stoma to create a sling of
mesh around the bowel proximal to the stoma
(Fig. 17.13 ). Placing mesh in this fashion
provides wide overlap of any additional midline
defects while creating a modifi ed Sugarbaker
confi guration around the stoma that was left in
situ (Fig. 17.14 ). Parastomal and midline defects
are primarily closed as described above .