Prosthetics for Parastomal Hernia Repair

It is an accepted fact that parastomal hernias are a common and frustrating problem. Traditional surgical techniques of direct fascial repair and stoma relocation have largely fallen out of favor because of their poor outcomes. Synthetic prosthetic grafts have long been used in the repair of other types of hernias. Despite their known risk factors, including infection and erosion into bowel, they have been used extensively in the surgical management of parastomal hernias. Recently, newer bioprosthetic materials are beginning to make an appearance in clinical trials with promising results. Placement of these prosthetics in the sublay or underlay positioning is associated with the best outcomes. Lastly, the technique of routing the bowel is a hotly debated point—whether routing should be done through the prosthetic (keyhole technique) or around the prosthetic (Sugarbaker technique). The majority of published studies have used the keyhole technique with a wide range of success rates. Recently, the Sugarbaker technique is gaining in popularity with promising early results.