Laparoscopic modified Sugarbaker technique results in superior recurrence rate

Abstract

Parastomal hernia (PH) is a frequent complication of stoma formation, occurring in 35-50% of patients. Recurrence after repair is common, ranging from 24 to 54% of cases. We hypothesized that repair using a laparoscopic modified Sugarbaker technique (SB) would result in a superior recurrence rate when compared with other repairs. An Institutional Review Board-approved retrospective review of patients who underwent PH repair between 2004 and 2011 was performed. We collected demographics, factors related to ostomy formation, risk factors for hernia, intraoperative and postoperative information, as well as the absence or presence of PH on their last physical examination or imaging study. Forty-nine PH repairs were performed: 33 (67%) para-ileostomy and 16 (33%) para-colostomy. Repairs included 14 laparoscopic modified SB, 19 laparoscopic keyhole, 11 ostomy re-sitings, and 5 open primary repairs. There was no statistically significant difference between groups when comparing age, BMI, smoking status, steroid use, ostomy type, location, primary diagnoses, or complication rate. Recurrence rates were 0% for SB, 58% for keyhole, 64% for re-siting, and 20% for open repair. When SB was compared with all groups, the incidence of recurrence was significantly lower (p < 0.001) but follow-up was as well (7.2 vs 32.7 months). When analysis was restricted to the 28 repairs performed between 2009 and 2011, there was no significant difference between the groups in terms of demographics or follow-up period (7.2 months for SB group versus 11.8 months for all others), but again there was a significant difference in recurrence (0 of 14 for the SB group vs 8 of 14, p < 0.01). In addition, there were no differences in postoperative complication rates among all techniques. The modified SB technique may offer patients a significant decrease in the risk of recurrence compared with other PH repair techniques with no significant increase in postoperative complications.