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Objective: Although stoma relocation is generally the first choice of treatment for parastomal hernia, a repair using polypropylene prosthetic mesh is sometimes employed in cases of parastomal hernia recurrence. Use of this mesh, however, has been associated with a high risk of bowel erosion, adhesions formation, and fistulization. We therefore began to use expanded polytetrafluoroethylene (ePTFE) mesh to perform an onlay parastomal hernia repair. Our initial clinical experience with this procedure is described., Patients and Methods: Sixteen patients aged 39-70 years with intractable stoma problems underwent a modified intra-abdominal onlay technique with implantation of a large (26 x 36 cm) sheet of ePTFE mesh., Results: During a median follow-up of 29 months (range, 5-52 months), no mesh-related bowel erosion, fistulization, or adhesion formation were observed. Two patients had a recurrence of the hernia due to technical failure. Re-operation in one of these resulted in wound dehiscence and removal of the contaminated mesh. Another patient developed intestinal obstruction postoperatively. The mesh was removed, and a gastrointestinal stromal tumour was found. Finally, a nonmesh related small bowel erosion required removal of the mesh in one patient. All other patients had full relief of symptoms., Conclusion: The modified onlay technique using a large sheet of ePTFE prosthetic mesh is a feasible option for treatment of parastomal hernia recurrence. Possible advantages of the procedure include stoma preservation, strengthening of the abdominal wall, and a reduced risk of recurrence, contamination, fistulization, and bowel adhesions and erosion.

The clinical outcome of contralateral prophylactic mastectomy (CPM) in women with a BRCA1 or BRCA2 mutation and a personal history of invasive breast cancer is unknown. We identified a cohort of 148 female BRCA1 or BRCA2 mutation carriers (115 and 33, respectively) who previously were treated for unilateral invasive breast cancer stages I-IIIa. In all, 79 women underwent a CPM, while the other women remained under intensive surveillance. The mean follow-up was 3.5 years and started at the time of CPM or at the date of mutation testing, whichever came last, that is, on average 5 years after diagnosis of the first breast cancer. One woman developed an invasive contralateral primary breast cancer after CPM, whereas six were observed in the surveillance group (P<0.001). Contralateral prophylactic mastectomy reduced the risk of contralateral breast cancer by 91%, independent of the effect of bilateral prophylactic oophorectomy (BPO). At 5 years follow-up, overall survival was 94% for the CPM group vs 77% for the surveillance group (P=0.03), but this was unexpectedly mostly due to higher mortality related with first breast cancer and ovarian cancer in the surveillance group. After adjustment for BPO in a multivariate Cox analysis, the CPM effect on overall survival was no longer significant. Our data show that CPM markedly reduces the risk of contralateral breast cancer among BRCA1 or BRCA2 mutation carriers with a history of breast cancer. Longer follow-up is needed to study the impact of CPM on contralateral breast cancer-specific survival. The choice for CPM is highly correlated with that for BPO, while only BPO leads to a significant improvement in overall survival so far.