Open Retromuscular Repair of Complex Parastomal Hernia

Hemasat Alkhatib, MD; Luciano Tastaldi, MD; Clayton C. Petro, MD; Dominykas Burneikis, MD; David M. Krpata, MD; Steven M. Rosenblatt, MD, FACS; Ajita S. Prabhu, MD, FACS; Michael J. Rosen, MD, FACS

Product Details
Product ID: ACS-5574
Year Produced: 2018
Length: 9 min.


Patient is placed in a supine position, prepped with chlorhexidine and the ostomy is covered with sterile gauze. We begin with a midline incision, dissection and adhesiolysis. Once the stoma is fully mobilized, the mucocutaneous junction is taken down. The abdominal viscera is covered with a blue towel. The prior mesh is removed. A retrorectus dissection is performed followed by a transversus abdominis release. The component separation begins above and below the defect where the abdominal planes are easier to identify. Using the previous dissection to orient us, we advance to the defect. The peritoneal space is developed. The resulting defects in the posterior sheath and peritoneum are repaired. A similar dissection is carried on the contralateral side. Before the posterior rectus sheath is entirely closed, the location of the new stoma exit point is measured by medializing the skin, anterior rectus fascia, and rectus to the midline. A TAP block is performed. We place a biologic mesh in diamond configuration, and secure it inferiorly to cooper's ligament and superiorly to the central tendon of the diaphragm. We place 3 transfacial sutures on the contralateral side of the stoma, tying them. On the side of the stoma, 3 sutures are placed, secured but left untied. The skin and subcutaneous tissue is pulled again to the midline and a cruciate incision is made. The bowel is pulled through. The remaining transfacial sutures are tied. The anterior rectus sheath is reapproximated using interrupted #1 maxon sutures. The skin is closed with staples.