Parastomal Hernia Repair Research Articles

V-005 Robot assisted parastomal hernia repair of an ileal conduit stoma

Abstract Aim The optimal surgical treatment of a parastomal hernia after ileal conduit urinary division has yet to be determined. Data is scarce and reported recurrence rates after different approaches in parastomal hernia repair remain high. Material & Methods A 65-year-old male patient, who had a history of a radical cystectomy with an ileal conduit urinary diversion, presented with a recurrent symptomatic parastomal hernia. He had a previous repair of his parastomal hernia via an open retromuscular approach with a unilateral posterior component separation (transversus abdominis release). Results A robot assisted repair of the recurrent parastomal hernia was performed using a partial intraperitoneal onlay mesh technique (PIPOM). Intraoperatively, intraluminal Indocyanine green (ICG) was used to identify the ileal conduit loop. A closure of the defect was performed with a barbed suture whereafter the repair was reinforced with a PVDF IPST ‘Chimney’ parastomal mesh. The latter being partially covered by peritoneum. The postoperative course was uneventful, and the patient went home on postoperative day one. The patient had no complications and a well-functioning ileal conduit stoma 6 weeks after surgery. Conclusions The repair of a recurrent parastomal hernia after ileal conduit urinary division represents a surgical challenge. After a previous retromuscular approach, a robotic assisted approach using a partial intraperitoneal onlay mesh technique (PIPOM) represents a feasible technique with promising results.

OC-013 MEDIUM-LONG TERM OUTCOMES OF RETROMUSCULAR PARASTOMAL HERNIA REPAIR WITH PAULI MODIFIED SUGAR BARKER PROCEDURE

Abstract Objective We aim to evaluate the outcomes and stoma complication in parastomal hernia repair (PHR) with Pauli procedure. Material and Methods 18 patients were recruited between 2015–2022 in 2 hospitals. Data were obtained from prospective clinical database. Surgical technique included: posterior component separation (TAR), bowel lateralization according to Pauli modified Sugarbaker and, if necessary, stoma relocation. Quantitative variables are shown as median [interquartile rank] and qualitative as percentage. Results 22.2% patients had recurrent PH with 2 [3] previous repair attempts. 22.2% underwent bilateral TAR and 11.1% required inlay mesh. Panniculectomy was performed in 17,8% of patients and stoma relocation in 44,4%; 17% required intestinal resection and 11,1% bowel suturing. Complications < 30days: 17% had surgical site infection (SSIs), 2 deep SSIs and one required surgical management. 22.2% had clinical seroma, one required percutaneous drainage and other surgical intervention. Postoperative complications were adynamic ileus (22,2%), bowel obstruction (5%) which was managed conservatively and anastomotic leakage (5%). No mortality was observed, and hospital-stay length was 8 [7.25] days. Complications > 30days: 5.5% chronic seroma (grade III), 5.5% PTE and 22.2% bowel obstruction of which one required adhesiolysis and another bowel resection. 27.8% had any stoma-related complication: partial ischemia (5.5%), retraction (11.1%), prolapse (5.5%) and obstruction (5.5%) managed conservatively. One patient required reoperation due to stoma perforation. We found 25% of clinical or radiological recurrence after 24 [20.1] months follow-up. Conclusion This technique provides acceptable recurrence rates of the PH, but is still high, with a non-negligible associated comorbidity.

OC-125 PARASTOMAL HERNIA REPAIR WITH THE MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE (PAULI PROCEDURE)

Abstract Aim Parastomal hernia can be treated by retromuscular mesh placement with transversus abdominis release (Pauli procedure). Since then, we established it as our standard procedure and report on our perioperative results and initial follow-up data. Material & Methods During a 4-year period (1/2019–12/2022), 20 consecutive patients were treated by Pauli procedure. All patients were prospectively registered in the Herniamed database. Follow up was performed by patient interview or patient review. Results Pauli Procedures were mainly (75%, n=15) performed by minimal-invasive techniques (Laparoscopic n=14, open n=4, robotic n=1). Thirteen patients had a urostomy and seven had a colostomy. Median hernia diameter was 5 cm (3–13 cm, EHS classification for parastomal hernia: 9×I, 6×III and 5×IV). Median Mesh size was 310 cm2 (150–750). Perioperative morbidity was 15% (n=3, Clavien Dindo Grade II). Median hospital stay was 4 days (range: 3–17). Median follow up was 13 months (range 6–43) with a recurrence rate of 20% (urostomy n=3, colostomy n=1). Conclusion Pauli repair of parastomal hernia can be performed routinely by minimal-invasive techniques. The perioperative risk is low. Further studies are necessary to reduce the recurrence rate.

P-047 REDUCING THE RISK OF MESH EROSION IN A MODIFIED RETROMUSCULAR SUGARBAKER TECHNIQUE FOR PARASTOMAL HERNIA REPAIR

Abstract Aim Modified retromuscular Sugarbaker procedure (SP) is a promising approach for parastomal hernia repair. However, its potential complications, including the risk of mesh erosion, encourages us to develop other techniques of mesh placement. We propose an addition to this parastomal retromuscular mesh reinforcement. Materials and Methods We present the case of a 53 year old-woman, with a history of proctocolectomy with end ileostomy due to anal adenocarcinoma, undergoing emergency surgery due to parastomal hernia incarceration. Sugarbaker repair was performed placing inlay composite mesh fixed with reabsorbable tackers. Subsequently, the patient was admitted for recurrent parastomal hernia and midline ventral hernia surgery. Results We performed a modified retromuscular SP as described by Pauli in 2016. After midline laparotomy, hernia content was reduced and extensive retromuscular dissection with transversus abdominis release (TAR) performed, placing a wide retromuscular polypropylene mesh prior to closing parastomal fascial defect. Stoma was parietalized from lateral to medial in an S-shaped configuration. We placed a segment of bioabsorbable mesh covering the parietalized stoma to avoid direct contact with the polypropylene mesh. No recurrence was detected 3 months after surgery, pending reassessment at 6 months. Conclusions This repair provides the benefits of an open posterior component separation with TAR, maintaining the biomechanics of a functional abdominal wall, whilst offering the advantages of mesh reinforcement in a modified Sugarbaker configuration. Our experience with this novel technique seems promising. Rate of mesh erosion is yet to be defined and requires long-term studies before widespread adoption, with special concern on mesh placement.

V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY Noah Frydenlund, Eric Li, Clayton Neill, Gergory Dumanian, and Joshua J. Meeks Noah FrydenlundNoah Frydenlund More articles by this author , Eric LiEric Li More articles by this author , Clayton NeillClayton Neill More articles by this author , Gergory DumanianGergory Dumanian More articles by this author , and Joshua J. MeeksJoshua J. Meeks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative hernia development, especially parastomal hernia (PSH), remains a challenging problem after radical cystectomy (RC). The incidence of incisional hernia (IH) has been reported to range from 5-15%, while PSHs occur between 15-65%. The use of prophylactic mesh sheets during RC has been shown to reduce the incidence of PSH in a recent randomized trial. We present our technique for the prophylactic use of soft polypropylene mesh strips as sutures at the time of RC as a potential alternative to mesh sheets and review our early experience. METHODS: A retrospective review of a single surgeon's experience with RC from January 2017 to July 2022 was performed. The inclusion criteria were the use of prophylactic parastomal and/or ventral mesh strips. Patients that required intra-operative assistance from plastic surgery for complex abdominal closure were excluded. Radiographic hernias were identified by radiology reports. Hernias that were noticeable on physical exam, symptomatic, or required operative repair were classified as clinical hernias. RESULTS: A total of 72 patients with prophylactic mesh strip placement during radical cystectomy were included. The average age was 73.5 years (Range 41-88 years), with an average follow of 10.8 months (range 1.1 – 63 months) and an average BMI of 27.9 (range 16.0 – 39.13). Sixty-one patients underwent RC with ileal conduit (IC), while 11 underwent RC with neobladder (NB) creation. 93% of the cases were performed robotically with extracorporeal diversion, and the remainder were open. In the RC with IC cohort, 54 patients had ventral and stomal mesh strips placed while 4 had ventral only and 3 had stomal only strips. Radiographic IH was reported in 6/69 (8.7%) patients with ventral mesh strips. Clinical IH was reported in 2/69 (2.9%) patients. For the RC/IC cohort, radiographic PSH was identified in 11/57 (19.3%) patients, and clinical PSH occurred in 6/57 (10.5%) patients. 2/57 (3.5%) patients underwent parastomal hernia repair, 2/57 (3.5%) developed stomal stenosis, and one patient underwent incisional hernia repair. No mesh-related complications were identified. CONCLUSIONS: The prophylactic use of mesh strips as sutures during RC may provide a safe and effective method to reduce postoperative hernia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e512 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noah Frydenlund More articles by this author Eric Li More articles by this author Clayton Neill More articles by this author Gergory Dumanian More articles by this author Joshua J. Meeks More articles by this author Expand All Advertisement PDF downloadLoading ...

Parastomal hernia repair: a five-year experience from a single centre in the UK.

Parastomal hernias can affect significantly quality of life in patients who often had underwent major operations. The incidence and recurrence is still high although many techniques have been introduced to improve outcomes. Hence, there is still no agreement on what procedure has better results when it comes to repairing a parostomal hernia. Our aim is to compare outcomes of laparoscopic and open parastomal hernia repair in terms of recurrence, reoperations, post-operative complications and length of stay. Sixty-three parastomal hernia repairs were performed in a single Colorectal Centre over a period of 4years. Eighteen procedures were performed laparoscopically and 45 open. All the 7 emergency procedures were approached open. Both the techniques showed to be safe with post-operative major complication rate (Clavien-Dindo III or above) of 9.52%. The laparoscopic group was found to have a shorter length of stay (p = 0.04) and earlier start of stoma function (p = 0.01), more uneventful recoveries (0.02) and less minor post-operative complications (Clavien-Dindo I or II-p = 0.01,) but similar recurrence rate (p = 0.41). In the open group, the placement of a mesh showed to reduce the rate of recurrence (p = 0.0001). However, this was not found in the laparoscopic approach. In conclusion, the laparoscopic approach showed do give less post-operative complications and a shorter length of stay, with no benefit in the recurrence rate. Considering the open technique, the use of a mesh seemed to reduce the rate of recurrence.

Surgical strategies for recurrent parastomal hernia after a primary repair with a Dynamesh® IPST mesh.

To introduce our surgical strategies for recurrent parastomal hernia after a primary repair with a Dynamesh® IPST mesh. Ten patients who underwent recurrent parastomal hernia repair with previous Dynamesh® IPST mesh use were analyzed retrospectively. Distinct surgery strategies were applied. Accordingly, we investigated the recurrence rate and postoperative complications in these patients, who were followed for an average of 35.9months after surgery. There was no recorded death and no readmission during the 30-day postoperative period. And the lap-re-do Sugarbaker group had no recurrence, whereas the open suture group had one recurrence (16.7%). One patient in the Sugarbaker group developed ileus and recovered conservatively during the follow-up period. There were no other complications, including seroma, mesh infection and bulging, or prolonged postoperative pain. We offer two predominant surgery strategies for recurrent parastomal hernia with a previous Dynamesh® IPST mesh usage, the open suture repair, and the Lap-re-do Sugarbaker repair. Even though the results of the Lap-re-do Sugarbaker repair are satisfactory, we recommend the open suture technique as it is safer in a setting of dense adhesions in recurrent parastomal hernias.

Contemporary Outcomes of Elective Parastomal Hernia Repair in Older Adults

Parastomal hernia is a challenging complication following ostomy creation; however, the incidence and long-term outcomes after elective parastomal hernia repair are poorly characterized. To describe the incidence and long-term outcomes after elective parastomal hernia repair. Using 100% Medicare claims, a retrospective cohort study of adult patients who underwent elective parastomal hernia repair between January 1, 2007, and December 31, 2015, was performed. Logistic regression and Cox proportional hazards models were used to evaluate mortality, complications, readmission, and reoperation after surgery. Analysis took place between February and May 2022. Parastomal hernia repair without ostomy resiting, parastomal hernia repair with ostomy resiting, and parastomal hernia repair with ostomy reversal. Mortality, complications, and readmission within 30 days of surgery and reoperation for recurrence (parastomal or incisional hernia repair) up to 5 years after surgery. A total of 17 625 patients underwent elective parastomal hernia repair (mean [SD] age, 73.3 [9.1] years; 10 059 female individuals [57.1%]). Overall, 7315 patients (41.5%) underwent parastomal hernia repair without ostomy resiting, 2744 (15.6%) underwent parastomal hernia repair with ostomy resiting, and 7566 (42.9%) underwent parastomal hernia repair with ostomy reversal. In the 30 days after surgery, 676 patients (3.8%) died, 7088 (40.2%) had a complication, and 1740 (9.9%) were readmitted. The overall adjusted 5-year cumulative incidence of reoperation was 21.1% and was highest for patients who underwent parastomal hernia repair with ostomy resiting (25.3% [95% CI, 25.2%-25.4%]) compared with patients who underwent parastomal hernia repair with ostomy reversal (18.8% [95% CI, 18.7%-18.8%]). Among patients whose ostomy was not reversed, the hazard of repeat parastomal hernia repair was the same for patients whose ostomy was resited vs those whose ostomy was not resited (adjusted hazard ratio, 0.93 [95% CI, 0.81-1.06]). In this study, more than 1 in 5 patients underwent another parastomal or incisional hernia repair within 5 years of surgery. Although this was lowest for patients who underwent ostomy reversal at their index operation, ostomy resiting was not superior to local repair. Understanding the long-term outcomes of this common elective operation may help inform decision-making between patients and surgeons regarding appropriate operative approach and timing of surgery.

Long-term Outcomes of Parastomal Hernia Repair—The Defect in Knowledge (and Abdominal Wall) Remains

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Median incisional hernia and double parastomal hernia repair with retromuscular prosthetic biomaterial mesh using SMART technique (Stapled Mesh Stoma Reinforcement Technique) after pelvic exenteration due to cancer

Patient aged 64 with parastomal hernia on a terminal colostomy and a Bricker ileal conduit following pelvic exenteration in the context of a locally advanced low rectal adenocarcinoma.

What is new in parastomal hernia repair: An overview

What is new in parastomal hernia repair: An overview

Totally laparoscopic combined perineal and parastomal hernia repair following pelvic exenteration and ileal conduit: A rare case report and technical aspects

Totally laparoscopic combined perineal and parastomal hernia repair following pelvic exenteration and ileal conduit: A rare case report and technical aspects

Gastric Outlet Obstruction Secondary to Incarcerated Stomach in Parastomal Hernia

Gastric outlet obstruction due to an incarcerated stomach in a parastomal hernia is extremely rare. Here, we present the management of such a case with a review of the literature. A 79-year-old woman presented with a 3-week history of postprandial vomiting and associated parastomal and epigastric pain. She had a loop colostomy created for severe fecal incontinence secondary to anal stenosis. Imaging revealed a large parastomal hernia with an incarcerated gastric antrum. She was initially managed nonoperatively with a nasogastric tube. She underwent a semi-elective open Sugarbaker mesh repair of the parastomal hernia with good results. Gastric outlet obstruction secondary to incarceration of the stomach in a parastomal hernia is uncommon. A conservative approach with nasogastric tube decompression is a reasonable initial approach in a patient who is not critically unwell, which allows time for consideration of different parastomal hernia repair techniques.

Sugarbaker Versus Keyhole Repair for Parastomal Hernia: a Systematic Review and Meta-analysis of Comparative Studies

IntroductionParastomal hernia is a debilitating complication of stoma creation. Parastomal hernia repair with mesh reduces recurrence rates in open and laparoscopic settings. Recent comparative studies conflict with previously pooled data on optimal mesh repair technique. The objective of this study is to examine parastomal hernia recurrence rates after Sugarbaker and keyhole repairs by performing an updated systematic review and meta-analysis of comparative studies. MethodsA systematic review of PubMed, MEDLINE, EMBASE, the Cochrane database, SCOPUS, and the PROSPERO registry was performed according to PRISMA 2020 guidelines (PROSPERO ID: CRD42021290483). Studies comparing parastomal hernia recurrences after Sugarbaker and keyhole repairs were included. Studies with overlapping patient cohorts (duplicate data), non-comparative studies, studies that did not report the primary outcome of interest, and studies not in the English language were excluded. Study bias was assessed using the Newcastle–Ottawa scale. Pooled mean differences (MD), odds ratios (OR), and risk ratios (RR) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I2 statistic. Forest plots and funnel plots were generated. Study quality was analyzed using MINORS. Additional subgroup analysis of modern studies was performed. ResultsTen comparative studies published between 2005 and 2021 from 5 countries were included for analysis comprising 347 Sugarbaker repairs and 246 keyhole repairs. There were no differences in patient age, sex, or BMI between the groups. There was no difference between the groups regarding surgical site infection (OR 0.78; CI 0.31–1.98; P = 0.61) or post-operative bowel obstruction (OR 0.76; CI 0.23–2.56; P = 0.66). Sugarbaker repairs were significantly less often associated with parastomal hernia recurrence when compared to keyhole repairs (OR 0.38; CI 0.18–0.78; P = 0.008). There was no significant heterogeneity among the studies comparing parastomal hernia recurrence (I2 = 32%; P = 0.15). Quality analysis revealed a median MINORS score of 11 (range 6–16). Subgroup analysis of studies performed after the previously published pooled analysis (2015–2021) revealed no significant difference in parastomal hernia recurrence between the two groups (OR 0.58; CI 0.24–1.38; P = 0.22) with a significant subgroup effect (P = 0.05). ConclusionsThough there were lower rates of parastomal hernia recurrence with Sugarbaker repairs on overall analysis, this phenomenon disappeared on subgroup analysis of modern studies. Randomized controlled trials with contemporary cohorts would help further evaluate these repairs and minimize potential bias.

Robotic hernia surgeryIV. English version : Robotic parastomal hernia repair. Video report and preliminary results.

The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of afunnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing acomprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition.

Risk factors and prevent strategy of parastomal hernia

Parastomal hernia is one of the common complications of stoma surgery with an incidence of more than 30%, which can be diagnosed by physical examination and abdominal CT. Risk factors of parastomal hernia might include stoma approaches including the selection of intestine, relationship between stoma and peritoneum, stoma location, aperture size, operation time and the patient's own conditions. It is essential to prevent parastomal hernia in order to improve patients' quality of life. Prophylactic mesh and perioperative care might prevent parastomal hernias. The mesh type might also influence the incidence of parastomal hernia. To reduce the incidence of recurrence of parastomal hernia, placement of mesh by the laparoscopic Sugarbaker technique was an effective surgical approach. How to prevent and repair parastomal hernia and cure parastomal hernia repair still needs further high-quality research to provide evidence.

Laparoscopic two-stage parastomal hernia repair using a sugarbaker approach overlapping the previous keyhole technique: a case report with video

article: Laparoscopic two-stage parastomal hernia repair using a sugarbaker approach overlapping the previous keyhole technique: a case report with video - Chirurgia 2022 December;35(6):387-9 - Minerva Medica - Journals

Outcomes of parastomal hernia repair after national centralization.

In 2010, it was decided to centralize parastomal hernia repairs to five specialized hernia centres in Denmark to improve outcomes. The aim of this nationwide cohort study was to evaluate whether centralization of parastomal hernia repairs has had an impact on outcomes. Specifically, readmission, reoperation for complication, and operation for recurrence were analysed before and after centralization. By merging clinical and administrative outcome data from the Danish Hernia Database with those from the Danish National Patient Registry, all patients undergoing parastomal hernia repair in Denmark from 1 January 2007 to 31 December 2018 were included. Centralization was defined as having at least 70 per cent of procedures were performed at one of the five national centres. Readmission, reoperation, and recurrence rates for emergency and elective repairs were evaluated before and after centralization. In total, 1062 patients were included. Median follow-up was 992 days. Overall, the centralization process took 7 years. For elective repairs, the readmission, reoperation, mortality, and recurrence rates were comparable before and after centralization, but more patients overall and more patients with co-morbidity were offered surgery after centralization. For emergency repairs, there was a significant reduction in rates of reoperation (from 44.9 per cent (48 of 107) to 23 per cent (14 of 62); P = 0.004) and mortality (from 10.3 per cent (11 of 107) to 2 per cent (1 of 62); P = 0.034) after centralization. Centralization led to more elective operations and better outcomes when emergency repair was needed. Centralization of parastomal hernia repair led to more patients receiving elective repair and significantly improved outcomes after emergency repair.

P-118 COMPLEX INCISIONAL HERNIA AFTER BRICKER PROCEDURE. A CASE REPORT

Abstract Aim To analyze the treatment and complications of gigant paraestomal eventration with a case report and literatura review Material and Methods a retrospective case report from our hospital and her evolution since her urology surgery in 2011 Results Female of 59 years old, with personal antecedents of arterial hypertension, simple cistectomy and Bricker's urinary derivation (cutaneus ureteroileostomy) in 2011 due to intersticial cistitis, parastomal incisional hernia repair with intraperitoneal mesh in 2015. The patient was derivated from urology consult for a huge paraestomal incisional hernia and personal history of obstructive uropathy and several infections of urinary tract since 2022. No obstruction clinic was associated. Elective surgery was performed with an Trasversus Abdominis Release (TAR) and moving previous urostoma: hernial sac disection and previous mesh explant. Opening Rives, Retzius spaces and transversus fasciotomy was realized. Middle line was reforzed and hernial defect was closed. Polipopilene mesh was fixed at middle line and pubis with no reabsorbible suture and reforced with haemosthatic sealant. Anterior fascia was closed fixing at middle line. At the end a new urostoma was made in ryght hypocondrium. In postoperative period the patient developed light anaemia. Following months, the patient has not other complications due to incisional hernia repair. Conclusions Many factors can contibute to incisional hernia such as obesity, hypertension, number of surgerys, age, sex… TAR technique can be useful with complex eventration but we can not forget the commorbilities association to this surgery (anemia, pulmonar Tromboembolism…)

V-039 EXPANDED INDICATION FOR LAPAROSCOPIC INTRACORPOREAL RECTUS MUSCLE APONEUROPLASTY (LIRA) IN PARASTOMAL HERNIA

Abstract Aims Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique for the repair of incisional hernias from M2 to M4, but using the basic concepts of the technique, it allows an extended indication for other types of hernias such as suprapubic, lateral, or as in our case, the parastomal. The aim is to present step by step the larparoscopic aponeuroplasty technique as an alternative for parastomal hernia repair, as a modification of the original LIRA-technique. Material & Methods We present a 56-year-old patient with a history of abdominoperineal resection in 2012, who presented a symptomatic parastomal hernia. Clinical examination and computed tomography (CT) showed a partially reducible type I parastomal hernia, 8×11cm. Results We begin by releasing adhesions and reducing the hernial sac, always with control of the vascular axis, avoiding ischemic events. We opened the peritoneum and the transversus muscle 1–2 cm from the edge of the defect. We closed the defect using the transversus muscle as well as the posterior rectus sheath. We reduce the pneumoperitoneum to adapt the mesh and fix it using non-absorbable tackers and fibrin glue coating. Conclusions The LIRA technique guarantees a reconstruction of the midline, reinforcing this area without tension in ventral hernias. Based on this condition, we apply the concepts in a parastomal hernia, the original technique being equally reproducible, providing the advantages of laparoscopic surgery in terms of less pain. and morbidity, and betting on the minimization of tension compared to primary closure, as well as less appearance of seroma.