Robotic Parastomal Hernia Repair With Biologic Mesh

Abstract

Parastomal hernia is a common and vexing problem after ileal conduit urinary diversion that can cause pain, bowel symptoms, and problems with the stoma appliance, resulting in leakage, odor, and impairment of quality of life. Historically, these hernias have been managed open surgically, which requires considerable dissection of the abdominal wall for mesh placement, and may also require relocating the stoma to the contralateral side. Further, open parastomal hernia repair can be a morbid procedure with recurrence rates of approximately 30%. We present our technique of robotic parastomal hernia repair with a biologic mesh. We used a biologic mesh with the keyhole technique to avoid risk of erosion into the bowel segment. We present a case series of 3 patients undergoing robotic parastomal hernia repair. The illustrative case in the video is that of a 63-year-old obese woman with a parastomal hernia resulting in poor stoma appliance adhesion and bothersome urinary leakage. Robotic repair was completed successfully without intraoperative complications in all 3 patients. The mean age was 72 years. Mean body mass index was 30 kg/m2. Mean operating time was 3.5 hours. Mean estimated blood loss was 7.5 mL. Mean length of hospital stay was 3 days. On follow-up, all 3 patients were asymptomatic with stoma appliance issues and had no recurrence. Our initial series suggests that robotic repair of parastomal hernia is safe and feasible with minimal morbidity and good short-term outcomes. Further studies are required to confirm the efficacy of our technique.