We conducted a retrospective observational cohort study of 21 consecutive patients with parastomal hernia (PSH) treated with intraperitoneal funnel mesh DynaMesh®-IPST-R or -IPST made of polyvinylidene fluoride (PVDF) between March 2019 and April 2023. As part of the preoperative diagnostics, a CT scan of the entire abdomen was performed in all patients.
The DynaMesh®-IPST mesh (FEG Textiltechnik, Germany), hereinafter referred to as IPST mesh, is a 3-dimensional mesh with a funnel (diameter = 2 cm, length = 4 cm) without a slit. It was originally developed for the prophylaxis of PSH. In the treatment of PSH, the mesh is either used in a hybrid approach [14–17], whereby the integrity of the mesh structure is maintained, or it is manually incised and sewn back together after application (not recommended). To maintain the integrity of the mesh structure, the DynaMesh®IPSTR mesh (FEG Textiltechnik, Germany) is available with a prefabricated slit with reinforced selvedges and a slightly larger funnel diameter (3 cm) to achieve sufficient overlap (Fig. 1).
The primary study outcome was the recurrence rate. Secondary outcomes were intraoperative and postoperative complications. For data collection, patient records from the first and all subsequent visits were used (SAP-ERP 6.0/EHP8/Netweaver 7.5). Postoperatively, patients presented in the outpatient clinic for follow-up and aftercare. At intervals of 90 days, 12 and 24 months, the patients received a questionnaire. In addition, all patients were recorded in the Herniamed registry. Patients with an oncological underlying disease are also regularly examined in special outpatient clinics. All mentioned information sources were used to determine complications and recurrences. The Clavien-Dindo classification [18] was used to evaluate postoperative complications. Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS® v27, IBM, USA)
Information on the surgical technique used:
Patients are placed in supine position. In case of a PSH in a terminal, descending stoma, a mini-laparotomy (length 1 cm) is first performed in the area of the right mid-abdomen along the anterior axillary line. A skin incision is made, followed by dissection through the subcutaneous tissue. First the fibres of the external oblique muscle, then the internal oblique muscle and the transverse abdominal muscle are identified. These muscle layers are held apart along their fibre orientation with Langenbeck hooks. The parietal peritoneum is opened under direct vision. The optic trocar is inserted into the abdominal cavity using a guide rod. Before inspecting the entire abdomen, a capnoperitoneum with a pressure of 14 mmHg is created. An additional 5 mm trocar is placed under vision in the area of the right lower abdomen along the middle scapular line. Another 5 mm trocar is introduced into the epigastrium, on the left side of the falciform ligament of the liver.
In case of a PSH following a terminal ileostomy or in the area of the ileum conduit, the optic trocar is placed along the anterior axillary line in the area of the left mid-abdomen. Two additional 5 mm trocars are also positioned along the anterior axillary line, in the area of the left upper and lower abdomen.
After insertion of the trocars, adhesiolysis is usually performed due to the patient’s pre-existing conditions. Subsequently, the fascia is closed with transfascial sutures (using the Endoclose device) with PDS 1 − 0. When closing the fascia, care is taken to ensure that there is no kinking of the bowel, as this can lead to an ileus/obstruction later on. Then the PVDF funnel mesh is introduced into the abdominal cavity and positioned around the stoma Fig. 2. The mesh is fixed to the ventral abdominal wall in double-crown technique using SorbaFix spiral tacks. The overlapping selvedges of the funnel are secured with a V-Lock suture. During this fixation, the mesentery is also included to prevent stoma prolapse.