Laparoscopic Repair of Parastomal Hernias

Parastomal hernia has been anatomically classified into four subtypes ( Fig. 4.1 ).

Subcutaneous: The hernia sac goes alongside the stoma into the subcutaneous tissue. This is the most common type of paracolostomy hernia.

Interstitial: The hernia sac is within the layers of the abdominal wall. This hernia is at a high risk for strangulation.

Peristomal: The bowel prolapses through a circumferential hernia sac enclosing the stoma.

Intrastomal: The hernia sac is between the intestinal wall and the everted intestinal layer.

Most hernia defects are lateral to the rectus abdominis muscle, alongside the mesentery of the emerging bowel, and medial and cephalad to the stoma loop.

Commonly the parastomal hernia sac is very large with a relatively small fascial defect.