Laparoscopic parastomal hernia repair using a nonslit mesh technique.

BACKGROUND: The management of parastomal hernia is associated with high morbidity and recurrence rates (20-70%). This study investigated a novel laparoscopic approach and evaluated its outcomes. METHODS: A consecutive multi-institutional series of patients undergoing parastomal hernia repair between 2001 and 2005 were analyzed retrospectively. Laparoscopy was used with modification of the open Sugarbaker technique. A nonslit expanded polytetrafluoroethylene (ePTFE) mesh was placed to provide 5-cm overlay coverage of the stoma and defect. Transfascial sutures secured the mesh, allowing the stoma to exit from the lateral edge. Five advanced laparoscopic surgeons performed all the procedures. The primary outcome measure was hernia recurrence. RESULTS: A total of 25 patients with a mean age of 60 years and a body mass index of 29 kg/m2 underwent surgery. Six of these patients had undergone previous mesh stoma revisions. The mean size of the hernia defect was 64 cm2, and the mean size of the mesh was 365 cm2. There were no conversions to open surgery. The overall postoperative morbidity was 23%, and the mean hospital length of stay was 3.3 days. One patient died of pulmonary complications; one patient had a trocar-site infection; and one patient had a mesh infection requiring mesh removal. During a median follow-up period of 19 months (range, 2-38 months), 4% (1/25) of the patients experienced recurrence. CONCLUSION: On the basis of this large case series, the laparoscopic nonslit mesh technique for the repair of parastomal hernias seems to be a promising approach for the reduction of hernia recurrence in experienced hands.

Surgeon-initiated screening colonoscopy program based on SAGES and ASCRS recommendations in a general surgery practice.

BACKGROUND: This study aimed to determine the utility of a screening colonoscopy program initiated by general surgeons in an academic center. METHODS: New patients presenting to three general surgeons who met screening colonoscopy indications were asked whether they had undergone colorectal cancer (CRC) screening. The patients who had not undergone CRC screening were offered screening colonoscopies or referred to their gastroenterologists. RESULTS: In the first 9-month period of the program, 200 patients who met the Society of American Gastrointestinal and Endoscopic Surgeons/American Society of Colon and Rectal Surgeons indications for CRC screening were asked whether they had undergone screenings. Only 46% (n = 92) reported any prior appropriate screenings. Of the patients who elected CRC screening by the surgeons, 55 underwent full colonoscopies (2 concurrently with hemorrhoidectomies), and 2 had flexible sigmoidoscopies. As a result of screening, 10 patients (18%) required treatment: 7 had polypectomies, 2 had partial colectomies, and 1 with an indication for surgery deferred treatment. CONCLUSIONS: Most of the patients presenting to the general surgeon likely have not had CRC screening, and diligence in making appropriate recommendations should be routine. Colonoscopic findings requiring intervention are not insignificant.