ABSTRACT
Background: The disappointing outcome of local fascial repair and stoma relocation in parastomal hernias has stimulated a variety of new techniques that use a prosthetic mesh for herniorrhaphy. Many of these procedures either carry the risk of mesh contamination or allow only a local repair. We established a method that allows both an aseptic operation and the management of concurrent incisional hernias
Methods: Thirty-two patients [20 males and 12 females] with a mean age of 56 years [range 52-69 years] with paracolostomy hernias in the period from September 1997 to September 2004 were included in this study. All the patients are assessed preoperatively and treated surgically by midline approach and a prosthetic mesh in the sublay position in a plane between the peritoneum and transversus abdominal muscle. The mean follow up of our patients was 4.5 years [range 6months-6 years]
Results: The mean duration of the operation was 150 minutes. The mean size of the mesh used was 15 x 30 cm. Their were no major intra operative complications. Four major postoperative complications developed. Small adhesive bowel obstruction, two patients developed severe wound infection and one patient developed pulmonary embolism the mean follow up period was 4.5 years [range 6 months - 6 years]. The overall recurrence rate verified by clinical and ultra sonographic examination is nearly 10%. Moreover two patients developed incisional hernia who had no problem with their old scar
Conclusion: it is our opinion that the use of a polypropylene mesh extraperitoneally in the sublay position for treatment of large paracolostomy hernias avoids the high recurrence rate seen with local repair or relocation of the stoma, avoids the complications seen with the intraperitoneal placement of the mesh and furthermore allows the possibility of repair of other fascial defects whether related to the mid line or not with safety, with no major intra operative complications, with no major wound Infection that warrants mesh removal and accepted low recurrence rates
ABSTRACT
The aim of this work is to define the endosonographic criteria of fistula in ano as a trial to avoid recurrent perianal fistula. 42 patients underwent endosonography preoperatively in an outpatient setting. Analysis of endosonographic findings revealed the presence of positive results in 38 cases for positive location of an internal opening. The following endosonographic criteria were demonstrated: [1] root like budding formed by the intersphincteric tract that contracts the internal sphincter [3 cases], the appearance of root like budding with internal sphincter defect [6 cases] and subepithelial breach connecting to intersphincteric tract through an internal sphincteric defect [29 cases]. False negative results were recorded in four cases. It is concluded from these findings that endosonography is of particular importance in locating the internal opening of the perianal fistula and hence helping in the prevention of recurrence