The modified laparoscopic keyhole parastomal hernia repair with in situ re-ostomy has low recurrence rate

Abstract Aim Parastomal hernias are complex findings with a high recurrence rate. Various methods were described for surgical repair. A new method for the treatment of parastomal hernias with extraperitoneal mesh placement was published in 2016 (Pauli et al.). Recently, open retromuscular repair has been shown to be safe, effective and durable (Beffa et al. 2017). Still, there are concerns regarding mesh related complications (Tastaldi et al. 2017). Material and Methods All patients who underwent an open or laparoscopic modified retromuscular Sugarbaker parastomal hernia repair at our institution were identified. We describe the patient characteristics, operative details, perioperative results and the follow-up. Results Between January 2018 to May 2021 14 patients received surgical repair for parastomal hernia at our institution. Eight of these patients received retromuscular extraperitoneal mesh placement (4 open, 4 laparoscopic) in the aforementioned technique. The median age was 72 years (65 – 85) and the median BMI was 31 kg/m² (26 – 34). Six patients had a urostomy and two had a colostomy. One patient had a recurrent parastomal hernia after previous intraabdominal mesh repair. The median operating time was 223 minutes (144 – 425). Median Mesh size was 300 cm² (225 – 750). Two minor complications (Clavien-Dindo Classification Grade II) demanding pharmacological treatment. The median hospital stay was 8 days (4 – 17). Median follow up was 17 month (range 1 – 26). Recurrence rate was 25 %. Conclusions The modified retromuscular sugerbaker technique seems to be safe and feasible as shown by our data. Due to the extraperitoneal mesh position, we see fundamental methodological advantages. Further studies are necessary for long-term results.

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Parastomal Hernia: A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up

World Journal of Surgery ◽

10.1007/s00268-021-05990-z ◽

2021 ◽

Author(s):

Elisa Mäkäräinen-Uhlbäck ◽

Jaana Vironen ◽

Ville Falenius ◽

Pia Nordström ◽

Anu Välikoski ◽

...

Keyword(s):

Cohort Study ◽

Hernia Repair ◽

Recurrence Rate ◽

Parastomal Hernia ◽

Complication Rates ◽

Recurrence Rates ◽

Parastomal Hernia Repair ◽

Operation Rate ◽

Repair Techniques

Abstract Background Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. Methods All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007–2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. Results In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007–2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0–146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. Conclusion The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.

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Parastomal Hernia Repair

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-014-2717-8 ◽

2014 ◽

Vol 19 (4) ◽

pp. 766-769 ◽

Cited By ~ 9

Author(s):

Conor H. O’Neill ◽

Edward C. Borrazzo ◽

Neil H. Hyman

Keyword(s):

Hernia Repair ◽

Parastomal Hernia ◽

Parastomal Hernia Repair

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Parastomal hernia repair

Laparoscopic Hernia Surgery ◽

10.1201/b13406-28 ◽

2002 ◽

pp. 161-168

Keyword(s):

Hernia Repair ◽

Parastomal Hernia ◽

Parastomal Hernia Repair

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OV18 ENDOSCOPIC RETRO-MUSCULAR REPAIR OF PARASTOMAL HERNIA - A TANTALIZING NEW TECHNIQUE

British Journal of Surgery ◽

10.1093/bjs/znab396.069 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Jan Roland Lambrecht

Keyword(s):

Hernia Repair ◽

Parastomal Hernia ◽

Abdominal Wall Hernia ◽

Transversus Abdominis ◽

Prophylactic Mesh ◽

Parastomal Hernia Repair ◽

Abdominal Wall Hernia Repair ◽

Video Demonstration ◽

Mesh Technique

Abstract Development of retro muscular space with transversus abdominis release has reached maturity in endoscopic surgery. Next-level reconstruction is adaptation to parastomal hernia repair alone or in conjunction with another abdominal wall hernia repair. We aim to present this extraperitoneal modified mesh technique based on the Sugarbaker principle with video demonstration and share clinical data and results from twenty-four patients operated with this technique within two years from the spring of 2019 to the spring of 2021. 77% patients had para-colostomy hernia and 41% of the patients had accessory repairs for midline or opposite flank hernia. 18% had prophylactic mesh at index operation, 27% were recurrent parastomal hernia and ostomies were formed median 32 months prior to parastomal hernia repair. 72% of the patients were operated robotically and 28% laparoscopically. Median follow up at time for presentation will be 17 months.

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