The safety of surgical technique for ileostomy and colostomy in preventing parastomal hernias: an in vitro experimental simulation study

Background!#!Parastomal hernia (PH) is a common long-term complication in persons with an ostomy. Although the cause of PH may be multifactorial, the surgical technique employed for the creation of a stoma may be a risk factor for the development of PH. The traditional technique of cruciate fascia incision may predispose to increased pressure zones at the ostomy exit site, thereby increasing the risk of PH. A circular excision of the abdominal fascia at the ostomy exit site enables a uniform pressure distribution, thereby reducing the risk of PH. This hypothesis was tested in this in vitro experimental simulation study.!##!Methods!#!The effect of the surgical technique for ostomy creation on the risk of PH development was investigated in this in vitro experimental simulation study. The pressure development at the stoma site was compared for the traditional cruciate incision vs. circular fascia excision.!##!Results!#!The pressure at the ostomy site was about four-times higher in the tradition cruciate incision technique compared to the circular excision technique. This finding was independent of unilateral (e.g. peritoneal) pressure application.!##!Conclusion!#!The main finding from this study suggests that the traditional cruciate incision of the abdominal fascia for the creation of an intestinal ostomy predisposes to increased pressures at the ostomy site, thus increasing the risk of PH. This effect is not seen in the experimental setting following a circular excision of the fascia. Thus, this surgical aspect may be adopted as a possible means of reducing the risk of parastomal hernia in patients undergoing ostomy surgery

Surgical management of hereditary colorectal cancer

Colorectal cancer (CRC) is one of the most common solid malignancies worldwide. Although sporadic CRC represents the most common form, genetic alterations is increasingly being identified in a relevant portion of patients with CRC. Familial CRC describes an increased incidence of adenomatous polyps and CRC in first - degree relatives. Hereditary CRC is defined by the identification of deleterious mutations in known predisposing genes. Typical hereditary syndromes with predisposition to CRC include: hereditary non-polyposis colon cancer or Lynch syndrome, familial adenomatous polyposis, attenuated familial adenomatous polyposis, Peutz-Jeghers syndrome and MUTYH associated polyposis. Newly identified genetic alterations with increased risk for CRC include: PPAP, NAD, MSH3 and NTHL1. The diagnosis, surveillance and optimal surgical management of patients with hereditary predisposition to CRC warrant a good understanding of the genetic syndrome in question. Prophylactic surgery must be segregated from symptom-related procedures depending on the syndrome in question. The need for extended surgical procedures must be made in an individualized manner based on gene and gender. The patient should play an active role in the surgical decision-making. Minimally invasive access should be the preferred approach and postoperative quality of life must be seen as a primary outcome measure