V-003 Parastomal & ileal conduit hernia: Top docking robotic eTEP approach

Abstract

Abstract Aim Parastomal hernias are frequent in patients with end colostomy. Recently, the robotic approach for the treatment of this pathology had spread abroad. On the other hand, patients with an ileal conduit urinary diversion after a radical cystoprostatectomy have a high risk of incisional hernia development. The combination of both parastomal hernia and ileal conduit hernia is rare. The aim of this video is to describe a top docking robotic eTEP approach combining a modified retromuscular Sugarbaker technique (Pauli) with a retromuscular keyhole for the parastomal and ileal conduit hernias respectively. Material and Methods The case is a 71 years old man patient with a BMI of 36 who presented a progressive 2-year discomfort bulging around the end colostomy that turned in an intermittent constipation. Additionally, a progressive bulging started the last 6 months on the ileal conduit. An abdominal CT scan was made showing a bilateral ostomal defect with small bowel parastomal content and fat tissue in the ileal conduit. Once the patient was assessed, a top docking robotic eTEP approach was planned with a Xi Da Vinci robotic platform. The patient was in a hyperextended supine position. Result The patient was discharged 3 days after the operation with a mild pain controlled by oral medication. Conclusion The Pauli technique and retromuscular keyhole for combined parastomal and ileal conduit hernia performed by a top docking robotic approach is feasible, but a long follow-up is needed to demonstrate its effectiveness.