Cohort Study Parastomal Hernia-Repair Using 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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Patients Undergoing Parastomal Hernia Repair Using the Americas Hernia Society Quality Collaborative: A Prospective Cohort Study

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.07.658 ◽

2018 ◽

Vol 227 (4) ◽

pp. 393-403.e1 ◽

Cited By ~ 2

Author(s):

Thomas Gavigan ◽

Thomas Stewart ◽

Brent Matthews ◽

Caroline Reinke

Keyword(s):

Cohort Study ◽

Hernia Repair ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Parastomal Hernia ◽

Parastomal Hernia Repair

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Comparing Sugarbaker versus keyhole mesh technique for open retromuscular parastomal hernia repair: study protocol for a registry-based randomized controlled trial

10.21203/rs.3.rs-970693/v1 ◽

2022 ◽

Author(s):

Benjamin T Miller ◽

Jonah D Thomas ◽

Chao Tu ◽

Adele Costanzo ◽

Lucas A Beffa ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Controlled Trial ◽

Hernia Repair ◽

Parastomal Hernia ◽

Controlled Trial ◽

Randomized Controlled ◽

Parastomal Hernia Repair ◽

Sugarbaker Technique ◽

Mesh Technique

Abstract BackgroundParastomal hernia, common after stoma creation, negatively impacts patient quality of life. For patients with a permanent stoma, durable parastomal hernia repair remains a challenge, with few high-quality studies for guidance. An alternative to open retromuscular parastomal hernia repair with retromuscular “keyhole” mesh is the recent Sugarbaker modification. We aim to compare these two techniques in a head-to-head prospective study.MethodsThis is a registry-based randomized controlled trial designed to investigate whether the retromuscular Sugarbaker technique is superior to the retromuscular keyhole technique for parastomal hernia repair. The primary study endpoint is parastomal hernia recurrence at two years. Secondary endpoints include hospital length-of-stay, readmission, wound morbidity, mesh-related complications, re-operation, all 30-day morbidity, and patient-reported outcomes, including hernia-related quality of life, stoma-specific quality of life, pain, and decision regret.DiscussionBased on the post hoc analysis of a recent randomized controlled trial, we hypothesize that the retromuscular Sugarbaker technique will reduce parastomal hernia recurrence by 20% at 2 years compared to the retromuscular keyhole mesh technique. The results of this study may provide evidence-based guidance for surgeons repairing parastomal hernias.Trial registrationClinicalTrials.gov NCT03972553. Registered June 3, 2019.

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Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study

BMC Surgery ◽

10.1186/s12893-021-01228-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elisa Mäkäräinen-Uhlbäck ◽

Jaana Vironen ◽

Markku Vaarala ◽

Pia Nordström ◽

Anu Välikoski ◽

...

Keyword(s):

Cohort Study ◽

Hernia Repair ◽

Urinary Diversion ◽

Complication Rate ◽

Parastomal Hernia ◽

Ileal Conduit ◽

Hernia Recurrence ◽

Complication Rates ◽

Parastomal Hernia Repair

Abstract Background Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion. Method All patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007–2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days’ follow-up. Results The results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21–64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days’ follow-up. Conclusion The results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence.

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Clinical outcomes after parastomal hernia repair with a polyester monofilament composite mesh: a cohort study of 79 consecutive patients

Hernia ◽

10.1007/s10029-017-1721-9 ◽

2018 ◽

Vol 22 (2) ◽

pp. 371-377 ◽

Cited By ~ 5

Author(s):

E. Oma ◽

B. Pilsgaard ◽

L. N. Jorgensen

Keyword(s):

Cohort Study ◽

Hernia Repair ◽

Clinical Outcomes ◽

Parastomal Hernia ◽

Composite Mesh ◽

Parastomal Hernia Repair ◽

Polyester Monofilament

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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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