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A New Classification of Parastomal Hernias - from the Experience at Bielański Hospital in Warsaw

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Gil G., owski M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 8
430-437
EN
Parastomal hernia is the most common local stoma complication. The incidence of parastomal hernia reaches 48%, and in a certain proportion of patients it is considered to be an inevitable consequence of stoma formation. The current classifications of parastomal hernias (Rubin, Devlin) are of little clinical value, which is supported by the fact that they have not been used in any publication presenting surgical treatment results in parastomal hernia. Moreover, these classifications do not include recommendations regarding surgical approach selection in those cases where surgical treatment is indicated. These disadvantages clearly indicate a need for developing a new classification of a greater practical value.The aim of the study was to present a suggested new parastomal hernia classification, based on structural criteria, and its use in surgical approach selection.Material and methods. The authors presented a group of 52 patients registered in Outpatient Stoma Clinic at Bielański Hospital in Warsaw, who had been diagnosed with parastomal hernia, defined as a type of hernia associated with postoperative artificial external intestinal fistula, who also had indications for surgical treatment of this stomal complication. These patients underwent a reconstructive procedure of their parastomal hernia with a surgical technique involving the placement of a monofilament polypropylene mesh in the preperitoneal space and repair of co-existing stomal complications using the variants of surgical techniques adequate for a given parastomal hernia type. Based on our studies and clinical experience, we propose a new classification of parastomal hernias, based on structural criteria. All hernias were divided into four groups (type I-IV) depending on hernia size and the presence of hernia in the postoperative scar. Qualification of a given hernia to a specific type was achieved based on physical examination, which makes the suggested classification a simple tool, useful in everyday practice. Each parastomal hernia type requires selecting a suitable surgical approach.Results. In the study group, 44 patients were diagnosed with primary hernia, and 8 - with recurrent hernia. In one case of recurrent hernia it was another recurrence. There were 11 type I hernias, 7 type II hernias, 24 type III hernias, and 4 type IV hernias in the study group. No statistically significant relationship between the type of hernia and the sex of the patients was observed for p = 0.05. However, there was a significant difference between the BMI values and individual hernia types. Patients with type I hernia had the lowest mean BMI value and patients with type IV hernia had the highest mean BMI value. The mean duration of postoperative follow-up was 58 months. There were 5 cases (9.6%) of parastomal hernia recurrence in the study group. A statistical analysis of the results showed that parastomal hernia types identified based on structural criteria differ from one another in parameters such as BMI, indications for surgery, or recurrence rates.Conclusions. The new classification of parastomal hernias is a simple way of identifying patients who require a different therapeutic approach. Thus, it has a practical application as it helps to select a suitable surgical technique. It may be also used for identification of homogeneous groups of patients and therefore allows for a reliable and objective comparison of treatment outcomes.
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The usefulness of anorectal manometry in patients with a stoma before and after surgery to restore the continuity of the gastrointestinal tract

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Zieliński T., Czyżewski P., Szczepkowski M., Zieliński T., Szczepkowski M.
Polish Journal of Surgery
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2016
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vol. 88(1)
1-6
EN
The operation to restore the continuity of the gastrointestinal tract is another surgical intervention in a given patient, which directly translates into an increased risk of complications during and after surgery. That is why proper qualification is important for the operation to restore the continuity of the gastrointestinal tract in terms of performance and efficiency of the anal sphincter apparatus, among other things. The aim of the study was to evaluate the effect of restoring physiological defecation routes on the sphincter function and to observe the parameters of anorectal manometry in patients before and after surgery to restore the continuity of the gastrointestinal tract. Material and methods. The study included 29 patients scheduled for restoration of the continuity of the gastrointestinal tract, 12 women and 17 men. The average age in the group was 62 years. Anorectal manometry was performed both before surgery as well as one month and three months afterwards in all patients. The average time to have a stoma was 12 months. Results. The resting pressure in the anal canal (MRP) three months after the restoration of the continuity of the gastrointestinal tract increased by 30.4%. The maximum systolic blood pressure in the anal canal (MSP) increased by 22.2%. The value of recto-anal inhibitory reflex (RAIR) decreased by 19.2%. The length of the high pressure zone in the anal canal (HPZL) increased by 27%. The study results of visceral rectal sensation thresholds decreased by 23.3% for the sensation threshold, and 14.4% for the pressure threshold. Conclusions. Restoring the continuity of the gastrointestinal tract improves the anal sphincter function which is evident in the parameters of anorectal manometry. The restoration of passage improves the sphincter function, and these changes are statistically significant.
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Patient Reoperations for Late Complications of Surgical Treatment of Parastomal Hernias – Own Experience

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Szczepkowski M., Gil G.
Polish Journal of Surgery
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2012
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vol. 84
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issue 10
495-501
EN
Parastomal hernias continue to be a significant clinical problem. Use of a synthetic material results in the best results of treatment of this pathology. However, treatment results are still unsatisfactory. is to present 6 cases of late complications of treatment of parastomal hernia using synthetic material, with successful surgical treatment. Material and methods. Among 52 surgical procedures of parastomal hernia repair using a synthetic material, 6 patients underwent late reoperation, including 4 women. Six reoperations were performed due to complications of parastomal hernia repair. Results. All cases of reoperation are presented and discussed in the study in order in which parastomal hernia repair procedures were performed. Conclusions. Presentation of 6 cases of patients treated for complications of the parastomal hernia repair procedure indicates that surgical technique of repair of this pathology is far from being perfect, although there has been a significant progress in this area over the past 20 years.
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