Parastomal hernia repair using the “top hat” technique - An initial experience in 30 patients at Memorial Sloan Kettering Cancer Center Journal Article


Authors: Fitzgerald, M. J.; Ullrich, S.; Singh, K.; Misholy, O.; Kingham, P.; Brady, M. S.
Article Title: Parastomal hernia repair using the “top hat” technique - An initial experience in 30 patients at Memorial Sloan Kettering Cancer Center
Abstract: Parastomal hernia repair remains a significant surgical challenge. Recurrence after standard “keyhole” or primary suture repair is common. We adopted and modified a new technique using a construct shaped like an inverted top hat. We review our experience over the last six years in the first 30 patients (31 consecutive procedures). Of these 31 procedures, six (19%) resulted in a parastomal hernia recurrence with a median follow-up of 31 months (range 0.5–80). Four of the recurrences occurred in our initial experience, when we constructed the top hat of xenograft alone. When the technique was modified, using a synthetic composite mesh for the underlay portion of the hat, there were only two subsequent recurrences in 16 patients (13%) with a median follow-up of 22 months. One of these “recurrences” was secondary to infection of the top hat construct, which had to be removed. This initial success in preventing recurrence of parastomal hernia is probably due to the design of the construct, for it occludes the vulnerable stoma/fascial angle, through which most parastomal hernia recurrences occur. © 2018 Elsevier Inc.
Keywords: adult; clinical article; aged; diarrhea; follow up; recurrence; smoking; kidney failure; abdominal pain; postoperative complication; operation duration; gout; recurrent disease; clostridium difficile infection; chronic pain; hematoma; seroma; wound infection; atrial fibrillation; wound complication; abdominal drainage; intestine surgery; hernioplasty; repair; small intestine obstruction; respiratory failure; neuralgia; parenteral nutrition; medical history; abscess; enterocutaneous fistula; thrombophlebitis; abdominal wall defect; human; male; female; priority journal; article; parastomal hernia; top hat; abdominal wall abscess; colon stoma; top hat technique; urinary stoma
Journal Title: American Journal of Surgery
Volume: 216
Issue: 3
ISSN: 0002-9610
Publisher: Elsevier Inc.  
Date Published: 2018-09-01
Start Page: 465
End Page: 470
Language: English
DOI: 10.1016/j.amjsurg.2018.02.018
PROVIDER: scopus
PUBMED: 29499860
DOI/URL:
Notes: Article -- Export Date: 1 October 2018 -- Source: Scopus
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MSK Authors
  1. T Peter Kingham
    281 Kingham
  2. Mary Sue Brady
    164 Brady
  3. Kumar Singh
    4 Singh