A novel approach for the simultaneous repair of large midline incisional and parastomal hernias with biological mesh and retrorectus reconstruction

IntroductionPatients with concomitant large midline incisional and parastomal hernias present many unique challenges to the reconstructive surgeon.MethodsWe describe a novel approach of simultaneously repairing the midline incisional and parastomal defect, while prophylactically reinforcing the relocated stoma site with a retrorectus biological graft.ResultsDuring the study period, 9 men and 3 women with a mean age of 65 years, body mass index (BMI) 34 kg/m2, and American Society of Anesthesiologists score (ASA) 3.1 underwent repair. Hernia defects averaged 338 cm2. Seven patients had a myofascial advancement flap. Mean operative time was 277 minutes. Postoperative complications occurred in 4 patients (33%) and included superficial surgical site infection, transient renal failure, and deep venous thrombosis; in addition, 1 patient died suddenly on postoperative day 3. After a mean follow-up of 14 months, 2 patients have asymptomatic hernia recurrence.ConclusionsThe use of various advanced abdominal wall reconstructive techniques may offer an acceptable approach to repairing these challenging defects.