The Clinical Application Of The Lap-re-Do Technique To Laparoscopic Parastomal Hernia Repairs

ObjectiveThis paper that retrospectively analyses the clinical data of parastomal hernia patients who have undergone laparoscopic repair in the department of general surgery in Huashan Hospital allows us to investigate the treatment results of the different operative methods. Also, we investigate the safety, feasibility, and advantage of a totally new technique, Lap-re-Do technique, for parastomal hernia repair. In addition, we evaluate the feasibility of single port laparoscopic surgery for parastomal hernia repair.Material and method1. MaterialWe retrospectively analyses87cases parastomal hernia patient’s clinical data who have undergone laparoscopic repair in the department of general surgery in Huashan Hospital, including19cases of Keyhole technique,24cases of Sugarbaker technique, and6cases of Sandwich technique, and3patients converted to conventional operation,35patients were performed under the Lap-re-Do technique, including2cases of single incision laparoscopic surgical (SILS) procedures.2. Method2.1Inclusive Criteria:During follow-up no tumor recurrence and no tumor happen; without other associated diseases during the hospital stay; excluding patients who convert to conventional operation; excluding the death patients.2.2Retrospectively analyses the clinical results of three different techniques of laparoscopic parastomal hernia repairs including Keyhole technique, Sugarbaker technique and Sandwich technique.2.3Retrospectively analyses the clinical results of the Lap-re-Do technique of laparoscopic parastomal hernia repairs.2.4Making reference to the function evaluation standard of anal rectum reconstruction, we draw up the function evaluation standard of artificial anus of parastomal hernia patients. Then we analyse the influence of four different operation techniques to the function and the appearance of artificial anus of parastomal hernia patients.2.5Retrospectively analyses the clinical results of SILS procedures for the parastomal hernia repairs.2.6All the data collected by SPSS17.0statistical. We calculate the median value and the outcome is presented. Kruskal-wallis test and Ridit analyses are used for statistics analyses.Results1.1Forty-nine patients were screened out, including19cases of Keyhole technique,24cases of Sugarbaker technique, and6cases of Sandwich technique. In all the cases, the Keyhole technique’s group has a high recurrence rate (78.9%,15/19), which has the shortest time of the first excreting gas (median time,2day) and the postoperative hospitalization (median time,5day). The Sugarbaker technique’s group has the shortest time of operation (median time,90min). In addition, there are procedure-related complications including16cases of temperately distention(Keyhole technique,2cases,10.5%, Sugarbaker technique,10cases,41.7%, Sandwich technique,4cases,66.7%) and13cases of seroma (Keyhole technique,4case,21.1%, Sugarbaker technique,8cases,33.3%, Sandwich technique,1case,16.7%). 1.2Thirsty-three patients were screened out from the patients using the Lap-re-Do technique. The recurrence rate of this technique is3.0%(1/33). The median time of operation, the first excreting gas and the postoperative hospitalization respectively is105min、3day、6day, and procedure-related complications appear in4cases.1.3Investigation shows that the function and the appearance of artificial anus of patients after the operations using Keyhole technique, Sugarbaker technique, and Sandwich technique are poor. But the function and appearance of artificial anus of patients are much better after the operation using Lap-re-Do technique, especially, in "whether difficult in defecation","defecation frequency", and "defecation time".1.4Two SILS procedures were performed successfully. The median time of operation, the first excreting gas and the postoperative hospitalization respectively is135/110min、3/2day、6/5day. There are no procedure-related complications. Both patients are asymptomatic with no sign of recurrence.ConclusionsTotally Laparoscopic parastomal hernia repair with mesh got a higher recurrence rate, especially using the Keyhole technique technique. The function and appearance of artificial anus of patients after the three Laparoscopic techniques is poor. But the recurrence rate is lower, the function and appearance of artificial anus of patients are much better after the operation using Lap-re-Do technique. We believe that laparoscopic parastomal hernia repair with Lap-re-Do technique is effective and feasible. In addition, the SILS procedure with Lap-re-Do technique is feasible.