肛肠外科学参考课件LAPAROSCOPIC PARASTOMAL HERNIAREPAIR WITH IPST MESH.ppt

LAPAROSCOPICPARASTOMALHERNIAREPAIRWITHIPSTMESH,MARCOSRODRIGUEZMARTINCOLORECTALUNITGREGORIOMARAONHOSPITALMADRIDSPAIN,INTRODUCTION,Parastomalhernia30%APRBadresultsOpenrepairFascialrepair46%Mesh20-29%Badresultsrelocationofstoma40%,INTRODUCTION,LaparoscopySugarbaker,INTRODUCTION,Sandwichtechnique,INTRODUCTION,AIM,NewlaparoscopictechniquewithIPSTMeshforthetreatmentofparastomalhernias,PATIENTSANDMETHODS,11PatientsJune2007toJune20096Male/5FemaleAge64,91years(31-80),PATIENTSANDMETHODS,Defectsize4,81cm(4-6cm),PATIENTSANDMETHODS,KindofStomaBricker7Colostomy3Ileostomy1,PATIENTSANDMETHODS,TrocarsVerresneedle(10)3trocars(9),RESULTS,Operativetime120min(60-175min)Hospitalstay7patients(1-3days)3patients(4-6days)1patient(60days),RESULTS,Sizeofmesh715x15125x25(20 x20)316x16x3(colostomy)1patienttreatmentofincisionalhernia,RESULTS,Recurrence:0patients(Follow-up12months)Complications:1mayorcomplication:Perforationofileostomy(reoperation)3minorcomplication2Seroma(1drainage)1Hematoma,CONCLUSIONS,EasyandfeasiblelaparoscopyctechniqueLowratesofrecurrenceAsumiblerateofcomplicationstraining,recomendations,(longtermresults),RECOMENDATIONS,PreoperativeCTSCAN(measureofdefect)Notrecomendedinbigholes(10cm)Useadaptedmesh(5cmmorethandefectsizeandadaptedsizeofhole),RECOMENDATIONS,Usedrainages(Intra