Peristomal Hernia Underlay Technique

Peristomal Hernia Underlay Technique

David E. Beck


Preoperative Preparation

Standard bowel preparation is not mandatory. However, because the empty colon handles better than the stool-filled colon, it is the author’s preference to have patients, who can tolerate a preparation, ingest a limited isotonic lavage prep, such as one-fourth to one-half gallon of a polyethylene glycol solution. Patients are instructed to take only clear liquids the day before surgery. Oral antibiotics are prescribed in patients with colostomies and all patients receive standard intravenous broad-spectrum antibiotics within 1 hour of skin incision. Deep vein prophylaxis is also ordered. Informed consent for laparoscopic procedures should include the potential for conversion to an open procedure.


Patient Positioning and Preparation

After induction of general anesthesia, an orogastric tube and indwelling urinary bladder catheter are placed. If a laparoscopic procedure is planned, the patient is then placed in modified lithotomy position with the thighs even with the hips and pressure points appropriately padded. One or both arms may be tucked to facilitate securing the patients for the extremes of positioning used during laparoscopy. If only one arm is tucked, it should be on the side opposite the side of the hernia and stoma. The patient is then secured to the table with straps or tape placed across the chest just below the armpits. The skin is prepped with antiseptic solution and draping is done in a manner to provide for lateral exposure for ports, especially on the side opposite the hernia and stoma. One author has suggested covering the abdominal wall with an adhesive drape to limit potential contamination of the mesh.