Preperitoneal approach to parastomal hernia with coexistent large incisional hernia

Objective To assess the outcome of preperitoneal mesh repair of complex incisional herniae incorporating a stoma and large parastomal hernia. Methods From 1994 to 1998, symptomatic patients who had repair of combined incisional hernia and parastomal hernia were reviewed. Body mass index, co‐morbidity, length of hospital stay, patient satisfaction and outcomes were recorded. Results Ten patients (seven females and three males), mean age 62 (range 48–80) years underwent primary repair. All had significant comorbidities (ASA grade 3) and mean body mass index was 31.1 (range 20–49). Median hospital stay was 15 (range 8–150) days. Complications were of varying clinical significance (seroma, superficial infection, major respiratory tract infection and stomal necrosis). There were no recurrences after a mean follow up of 54 (range 22–69) months. Conclusion The combination of a parastomal hernia and generalised wound dehiscence is an uncommon but difficult problem. The application of the principles of low‐tension mesh repair can provide a satisfactory outcome and low recurrence rate. This must be tempered by recognition of the potential for significant major postoperative complication.