Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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After stoma formation, parastomal hernia develops in 30-50% of patients, with one-third of these require operative correction. Recurrence rates are very high after suture repair of parastomal hernias or relocation of the stoma. Open or laparoscopic mesh repairs have resulted in much lower recurrence rates. ⋯ A prophylactic prosthetic mesh placed in a sublay position at the index operation has reduced the rate of parastomal hernia in randomized trials. A prophylactic mesh in an onlay position, a sublay position, and an intraperitoneal onlay position has also been associated with low herniation rates in non-randomized studies. Although several questions within this field still have to be answered, it seems obvious that use of a mesh represents a suitable measure for the prevention of parastomal hernia as well as parastomal hernia repair.
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Incisional hernias are the most common long-term complication after laparotomy with a cumulative incidence up to 20%. Generally all injuries to the integrity of the abdominal wall can result in the development of an incisional hernia. Midline and transverse incisions cause similar hernia rates. ⋯ Results from randomized controlled trials have not yet demonstrated a superiority of laparoscope-assisted procedures compared to laparotomy for the prevention of incisional hernias. Access through natural orifices and removal of specimens through the same approach (NOTES) may prevent incisional hernias completely. The approach to the abdominal cavity has to be chosen according to the underlying disease of the patient, the anatomical conditions and further circumstances (e.g. urgency, extensibility, preservation of function of the abdominal wall and safety).