Commentary on the article “Video-assisted preperitoneal repair of parastomal hernia” of Andrzej Jamry

It was with great interest that I read the article titled “Video-assisted preperitoneal repair of para- ­stomal hernia” published in Videosurgery and other miniinvasive techniques [1].

Since I am honoured to manage the Department of General Surgery in Bielanski Hospital, whose patients represent the largest group in Poland operated on due to parastomal hernias and one of the most widely described groups in the world literature, I took the liberty of commenting on the matter.

The author of the article describes a case of a 64-year-old female patient who has been operated on several times due to colonic carcinoma and its recurrence complicated by an internal fistula from the small bowel to the rectal stump. After the last surgery, a large, symptomatic, parastomal hernia occurred which deteriorated the condition of the patient’s life considerably.

Painful sensations and difficulties connected with the supply of medical support equipment caused social isolation of the patient, who was, according to the author, otherwise in a relatively good state of health. Having taken into account carcinoma progression, past adjuvant therapy, increased risk for poor or delayed wound healing and expected peritoneal adhesions making laparoscopy contraindicated, the author decided to perform miniinvasive repair of the hernia. A polypropylene mesh (Surgipro), sized 12 × 12 cm, was placed within the preperitoneal cavity. Postoperative course was uncomplicated and hernia recurrence was not observed within 12 months following the procedure.

I congratulate the author on the success, but still I have a few remarks to make.

There are three fundamental methods available for hernia surgical repair: relocation of stoma, procedures using autologous tissue, and procedures using synthetic materials. As they are associated with a high recurrence rate, even up to 100%, the first two cannot be treated as methods of choice [2-10] and therefore they are inadvisable to be performed electively. Their application appears to be limited to emergent surgical situations, particularly if intraoperative, massive infection of the operative field occurs, caused by necrosis, intestine perforation or resection.

Potential contamination of prosthetic material and possible following complications necessitating surgical removal of a mesh present a much greater threat than the recurrence itself.

The...


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