Parastomal Hernia Research Articles

HPB SO14 - Surprise Inside: Gallbladder Herniation in a Parastomal Hernia - A Rare Case Report and Management Insight

Abstract Background Parastomal hernias are a common complication of stoma formation, affecting approximately 40% of patients within two years. Gallbladder herniation within a parastomal hernia is a rare phenomenon, with only 18 cases previously reported. Patients are typically elderly females, with the condition attributed to ageing factors such as loss of visceral fat and elastic tissue, liver shrinkage, and the increased length and loss of elasticity of the gallbladder mesentery. These factors contribute to visceroptosis of the gallbladder, increasing its mobility and the risk of herniation. Method We present the case of a 68-year-old female with a four-day history of severe parastomal hernia pain and swelling. She had an emergency left hemicolectomy and transverse colostomy in the right upper quadrant 10 years prior for ischaemic colitis and perforation. Her stoma was functioning well. Vital signs and biochemistry results were normal. On examination her hernia was severely tender but partially reducible. CT revealed a right upper abdominal parastomal hernia containing loops of colon and surprisingly the gallbladder with a long stretched cystic duct. There was no evidence of cholecystitis, bowel obstruction, or compromise within the hernial sac. Results With analgesia, the patient's pain improved, though her hernia remained irreducible. She was discharged after two days of conservative management and referred back to the hospital where she had the initial operation. On enquiry with that hospital it was reported that an elective parastomal hernia repair with completion right colectomy and end ileostomy was performed. The gallbladder was mobilised and reduced back into the peritoneal cavity, and the hernial defect was closed. The patient made an excellent recovery and was discharged home three days after surgery. Conclusion Cholecystic parastomal herniation is a very rare phenomenon and should be considered as a differential in similar cases. Management should be based on clinical presentation, radiological diagnosis, and a multidisciplinary team approach. No standardised classification or approach exists. We propose classifying gallbladder herniations as either being simple (without inflammatory sequelae) or complicated (with cholecystitis, gallbladder torsion, incarceration or perforation). Simple herniations, such as the case presented, can be managed electively with intra-operative reduction of the gallbladder sufficing. Complicated herniations during acute admissions indicate the need for emergency surgical intervention with combined cholecystectomy and parastomal hernia repair.

Long-term outcomes after open parastomal hernia repair at a high-volume center.

Open parastomal hernia repairs (OPHR) are complex with high recurrence rates and no clear optimal technique. This report summarizes long-term OPHR outcomes at a high-volume hernia center. OPHRs were identified from a prospectively maintained institutional database. Recurrence and wound complication rates were compared across operative techniques using standard statistical analysis. Of 97 OPHR patients, mean age was 61.9 ± 12.6years, 56.7% were female, 24.7% were diabetic, and average BMI was 31.3 ± 6.5kg/m2. Mean defect size was 125.3 ± 130.0cm2 and 41.2% were recurrent. Stomas included colostomies (56.7%), ileostomies (30.9%), and urostomies (12.4%). Patients underwent concurrent ventral hernia repair (56.7%), panniculectomy (22.7%), and component separation (30.9%). Patients either had their stoma reversed (13.4%), resited (25.8%), or repaired in situ (60.8%) with suture (11.9%) or mesh (88.1%) in a Sugarbaker (65.4%), keyhole (19.2%), or onlay (15.4%) configuration. Over a mean follow-up of 31.6 ± 35.9months, wound complications occurred in 18.6% and recurrences in 20.6%. There were no significant differences in recurrence by ostomy type. Recurrence rates were highest after in situ suture repair (42.9%), followed by resiting with mesh (34.8%), in situ with mesh (17.3%), and reversal (0.0%)(p = 0.042). When stomas were resited, prophylactic mesh compared to no mesh did not significantly impact recurrence (28.6%vs.50.0%;p = 0.570). Recurrence rates for in situ repairs were not statistically different by mesh technique (onlay 25.0%, Sugarbaker 17.7%, keyhole 10.0%;p = 0.751), but differed by location(retrorectus 50.0%, intraperitoneal 36.4%, onlay 25.0%, preperitoneal 6.5%;p = 0.035). Multivariable analysis did not demonstrate any independent predictors of recurrence or wound complications. This study represents the largest series to date describing long-term OPHR outcomes with a variety of techniques. Recurrence was greatest after in situ primary repair. There were no recurrences after stoma reversal. After ostomy resiting, all recurrences occurred at the new stoma site, independent of prophylactic mesh use. When the stoma was repaired in situ, preperitoneal mesh placement had the lowest recurrence. Optimal technique for OPHR remains unclear, but these results may inform preoperative discussions and surgical planning.

Surgical Outcomes after Laparoscopic Repairs of Para-colostomy Hernia and Para-ileal-conduit Hernia: A Comparative Study.

The aim of the study was to investigate the differences in clinical characteristics and surgical outcomes between para-colostomy hernia (PCH) and para-ileal-conduit hernia (PICH) after laparoscopic repairs. We retrospectively analyzed data from 41 laparoscopic parastomal hernia repairs performed at the Jikei University Daisan Hospital between June 2012 and September 2023. The data were divided into PCH (n=31) and PICH (n=10) groups and compared. The comparison of patient backgrounds and hernia characteristics showed no significant differences between PCH and PICH groups. Surgical procedures included laparoscopic Sugarbaker repair (LSB) for PCH (29 cases) and PICH (8 cases), and endoscopic Pauli repair (ePauli) for both PCH (2 cases) and PICH (2 cases). Intraoperative findings indicated a significantly higher rate of severe intra-abdominal adhesions (Zühlke index III/IV) in the PICH group (60%) compared to the PCH group (23%) (p=0.0485). The median operation time was significantly longer for PICH (223 [120-423] minutes) than for PCH (158 [48-386] minutes) (p=0.0467). Perioperative complications occurred in 1 PCH case (3%) and 2 PICH cases (20%), with no significant difference in postoperative hospital stay (9 [4-19] vs. 9 [6-14] days). With the follow-up period of 57 [2-110] months for PCH and 52 [20-104] months for PICH, recurrence was observed in 4 PCH cases (12%) but not statistically significant. The comparison of PCH and PICH suggests that PICH is associated with more severe intra-abdominal adhesions and longer operation times, indicating higher operative difficulty. Therefore, it would be advisable to discuss the surgical outcomes of repair for these stomas separately.

Minimally Invasive Pauli Parastomal Hernia Repair.

Although originally described as an open procedure, the application in the setting of minimally invasive surgery of the Pauli technique for parastomal hernia repair is gaining interest among surgeons owing to encouraging early results. We aimed at combining and analyzing the results of minimally invasive Pauli repair by assessing the available evidence. A literature search in Pubmed, Embase, and Web of Science was undertaken to include all articles reporting on minimally invasive repair of parastomal hernias using the Pauli technique. Data regarding a total of 75 patients across 11 articles published between 2019 and 2023 were included. Patients received surgery either by a laparoscopic (27%) or robotic (73%) approach. A transabdominal route was chosen in 62 patients (83%), while an extraperitoneal technique was employed in the remaining 13 patients. The rate of postoperative morbidity was 34%, with 10% being the incidence of grade >II complications. The reported overall rate of recurrence was 7% at a median follow-up of 1 to 43 months. The available evidence derived from a growing number of centers suggests that minimally invasive Pauli repair is a viable option to treat parastomal hernias. Despite robust, high-level data still lacking, preliminary experiences indicate promising results.

Risk factors for parastomal hernia after abdominoperineal resection of rectal cancer.

To investigate risk factors associated with the formation of parastomal hernia after Miles operation, and to provide scientific evidence for the prevention and treatment of parastomal hernia. Clinical data from 205 patients with rectal cancer undergoing Miles operation in the Department of General Surgery, Affiliated Hospital of Xuzhou Medical University between May 2016 and May 2021 were analyzed retrospectively. Fourteen potential factors were selected and analyzed by single factor analysis and two element logistic regression analysis for their potential relationship to incidence of parastomal hernia. 49 cases of parastomal hernia occurred among 194 patients during follow-up (incidence 25.26%). Univariate analysis showed that age, thickness of subcutaneous abdominal fat, BMI, and stoma pathway were related to the formation of post-surgical parastomal hernia (P < 0.05). Two element logistic regression analysis showed that advanced age, thickness of subcutaneous abdominal fat, BMI > 25 kg/m2, and transperitoneal surgical approach were independent risk factors for the formation of parastomal hernia after Miles operation (P < 0.05). Advanced age, thickness of subcutaneous abdominal fat, BMI > 25 kg/m2, and transperitoneal surgical approach are independent risk factors for the formation of parastomal hernia after Miles.

Parastomal Gallbladder Herniations: A Systematic Review.

Parastomal hernias (PSHs) are a common complication following stoma placement. The presence of the gallbladder within a PSH is a rare and unusual occurrence, posing a significant management challenge for surgeons once encountered. We conducted a systematic review of the literature to evaluate the management and outcomes of parastomal gallbladder herniations. A comprehensive search was performed across the PubMed, Embase, and Medline databases using the search terms "gallbladder" AND "parastomal hernia." Additionally, a reference check of the results was conducted to identify further case reports. Eighteen case reports were included in the review. The mean age of the reported cases was 77.2 years, with a female predominance of 88.9% (n = 16). Seventy-seven percent (n = 14) of patients had an original ileal stoma or conduit. The average duration from stoma placement to clinical presentation was 5.8 years and abdominal pain was the most common presenting complaint. CT imaging was the most frequently utilised modality for successful diagnosis, with only two herniations identified during surgical exploration. Notably, 66.6% (n = 12) of patients experienced associated gallbladder complications, including cholecystitis, torsion, incarceration, and even perforation, all of which necessitated cholecystectomy. Cholecystic parastomal herniation is a rare phenomenon that should be considered in differential diagnoses for similar presentations. Currently, no standardized classification or management approach exists. Based on our findings, we propose classifying gallbladder herniations into two categories: simple (without inflammatory sequelae) and complicated (with cholecystitis, gallbladder torsion, incarceration, or perforation). Simple herniations may be managed electively with intraoperative reduction of the gallbladder. In contrast, complicated herniations presenting during acute admissions require emergency surgical intervention, involving a combined cholecystectomy and PSH repair.

Establishment and evaluation of rat models of parastomal hernia.

Parastomal hernia poses a challenging problem in the field of hernia surgery. The high incidence and recurrence rates of parastomal hernia necessitate surgeons to enhance surgical techniques and repair materials. This study aimed to develop a rat model of parastomal hernia by inducing various types of defects on the abdominal wall with colostomy. This established method has potential for future studies on parastomal hernia. In this study, 32 male rats were included and randomly divided into four groups: the oblique abdominis excision (OE), oblique abdominis dissection (OD), rectus abdominis excision (RE), and rectus abdominis dissection (RD) groups. In each group, colostomy was performed and an abdominal wall defect was induced. The rats were observed for 28days following surgery. The survival rate, body weight, parastomal hernia model scores, abdominal wall adhesion and inflammation, and collagen level in the hernial sac were compared. No significant differences in survival rate and weight were observed among the four groups. The parastomal hernia model scores in the RE and RD groups were significantly higher than those in the OE and OD groups. The ratio of collagen I/III in the RE and RD groups was significantly lower than that in the OE and OD groups. Adhesion and inflammation levels were lower in the RE group than in the RD group. Based on a comprehensive comparison of the findings, RE with colostomy emerged as the optimal approach for establishing parastomal hernia models in rats.

Evaluating EHS parastomal hernia classification for surgical planning: a retrospective analysis of 160 consecutive cases in a single center.

Parastomal hernia (PH) is a prevalent complication following ostomy formation, presenting significant challenges in surgical management. This study aims to validate the European Hernia Society classification for PH through the application of the Hybrid Parastomal Endoscopic Repair (HyPER) method. The study focuses on establishing the practical utility of the European Hernia Society classification in a clinical setting, particularly in guiding surgical approaches and improving patient outcomes. This retrospective observational study aimed to assess the utility of the European Hernia Society classification in planning surgical strategies for parastomal hernias. The validation of the classification of PH was based on the experience involving 160 patients in single center. Patients were classified according to the European Hernia Society criteria, and data were collected on patient demographics, clinical presentations, and surgical outcomes. Main goal was to assess the consistency and applicability of the European Hernia Society classification in predicting surgical challenges and outcomes. The study found a predominance of complex Type III and IV hernias. The European Hernia Society classification was effective in categorizing PH, aiding in surgical planning and highlighting the increased complication rates associated with more complex hernia types. This study represents the largest single-center cohort treated for PH by a single team, providing a controlled evaluation of the HyPER technique's effectiveness. The validation of the European Hernia Society classification in this study is a significant advancement in the standardization of PH management. The findings demonstrate the classification's utility in enhancing surgical planning and patient-centered care. The study also opens avenues for further research into standardized approaches and techniques in PH treatment.

Lap-re-Do Keyhole versus Lap-re-Do Sugarbaker techniques in large parastomal hernia repair: a retrospective cohort study.

To review the safety and efficacy of Lap-re-Do technique in the treatment of large parastomal hernia. We retrospectively analyzed the recurrence and complications of 81 patients with large parastomal hernia who underwent Lap-re-Do technique in Huashan Hospital of Fudan University from May 2010 to December 2019. And the patients should be able to complete follow-up. With such criteria, we included 40 Lap-re-Do Keyhole patients and 41 Lap-re-Do Sugarbaker patients. Observation time was defined as time to recurrence, death, or last nonevent visit. In large parastomal hernias, Lap-re-Do had a recurrence rate of 25.9% and complication rate of 16.0%, and reoperation rate of 9.9% during the average follow-up time of 41.1 ± 17.8 months. Recurrence rates were 40% (16/40) after Lap-re-Do Keyhole repair and 12.2% (5/41) after Lap-re-Do Sugarbaker repair. Complication rates were 12.5% after Lap-re-Do keyhole and 19.5% after Lap-re-Do Sugarbaker repair Re-operation rates referred to Lap-re-Do keyhole repair were 15% and Lap-re-Do Sugarbaker repair 4.9% during follow-up.The majority of reoperations were indicated by recurrence. Large parastomal hernias are still difficult to be treated. Lap-re-Do Sugarbaker is recommended as an appropriate procedure to close the hernia ring, removing the lengthy colostomy, and effectively reduce recurrence and complication rates.

Prophylactic onlay mesh placement to prevent parastomal hernia in patients undergoing abdominoperineal resection: A prospective comparative study a year follow-up, a single-center experience

Prophylactic onlay mesh placement to prevent parastomal hernia in patients undergoing abdominoperineal resection: A prospective comparative study a year follow-up, a single-center experience

The rate of ileostomy site incisional hernias: more common than we think?

Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort. A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted. All CTs scans were independently reviewed by staff surgeons to determine the presence of a fascial defect at the DLI-R site. 2,196 patients underwent DLI-R; of these, 569 (25.9%) underwent CT imaging for any indication. Mean patient age, 54.8 (± 14.9), BMI 27.6kg/m2. 87 (15%) patients had a parastomal hernia at time of DLI-R. After median follow-up of 10 months, 203 patients (35.7%) had IH at the DLI-R site. Age (p = 0.14), sex (p = 0.39), race (p = 0.75), and smoking status (p = 0.82) weren't associated with IH after DLI-R. Comorbidities weren't significantly associated with IH following DLI-R. In univariate analysis, increased BMI (p < 0.001), presence of a parastomal hernia (p = 0.008), and suture type (p = 0.01) were associated with IH development. On multivariate analysis, BMI remained significant, and polyglyconate compared to polydioxanone suture were associated with higher rates of IH (p < 0.001). We observed that the rate of incisional hernias within 1-year of diverting ileostomy reversal was indeed common at 36%. Granted, a high percentage of the population was excluded due to heterogeneity in radiographic evaluation that could be mitigated in future prospective studies. Our study suggests that IH preventative strategies include weight loss for overweight and obese patients prior to DLI-R and that the optimal suture for DLI-R is polydioxanone.

Parastomal hernia as possible cause of conduit perforation accompanied by fecal lithiasis on old suture stitches

Parastomal hernia as possible cause of conduit perforation accompanied by fecal lithiasis on old suture stitches

Parastomal hernia after ileal conduit: Incidence, natural history and risk factors.

Parastomal hernias are a challenging complication of digestive ostomies. Ileal-conduit parastomal hernias after cystectomy have specific aspects. The aim of this study was to describe the incidence and natural history of ileal-conduit parastomal hernias in order to guide their management, as well as to identify risk factors to prevent them. All consecutive patients undergoing cystectomy with a Bricker's ileal conduit in 3 academic centers were retrospectively identified. Data were collected regarding their medical history prior to cystectomy, the operation, the postoperative period, imaging results within 5years of follow-up, and the onset and timing of clinically or radiologically diagnosed ICPH. Among 577 patients included in the study, 115 (20.6%) developed an ICPH during the study period. Most patients did not present any symptom and the diagnosis was made at imaging in 74.8% of them. Most hernias were detected between 1 and 2years after the cystectomy, with a mean time to diagnosis of 12.4months. At multivariate analysis, overweight and obesity were independent risk factors for developing an ICPH (adjusted hazard ratio [aHR] 1.96; p=0.046), while a trans-rectus position of the ostomy was a significant protective factor (aHR 0.45; p=0.011). A PH develops in almost 20% of patients after ileal conduit urinary diversion, with a mean time of onset of 12.4months. It is often a subclinical condition detected at medical imaging. Obesity increases the risk, while passing the ileal-conduit through the rectus muscle can help to prevent it.

Application of modified extralevator abdominoperineal excision for low rectal cancer resection.

Laparoscopic ELAPE surgery has been carried out in our center for a long time, and some modifications have been made in clinical practice. In this study, we compared conventional ELAPE operation with modified ELAPE operation to investigate the efficacy and safety of modified ELAPE operation. We retrospectively analyzed the data from 339 patients with low rectal cancer undergoing abdominoperineal resection from 2017 to 2021 in the Department of General Surgery, Qilu Hospital of Shandong University. Patients were classified into modified ELAPE groups (199 patients) and conventional ELAPE groups (140 patients). Total operation time, reconstruction time, postoperative hospital stay, total cost, intraoperative data, postoperative short-term and long-term complications and tumor recurrence were compared. The baseline characteristics were comparable between the two groups. Total operation time was less with modified ELAPE group compared to conventional ELAPE group (190.6 ± 33.1min vs 230.1 ± 51.6min, P = 0.022). Pelvic floor reconstruction time was also less with modified ELAPE group compared to conventional ELAPE group (4.3 ± 1.2min vs 11.9 ± 1.7min, P = 0.004). Positive CRM was observed in 11 and 9 patients in modified ELAPE groups and conventional ELAPE groups (P = 0.744). IOP occurred in 12 and 7 patients in modified ELAPE group and conventional ELAPE group (P = 0.701). Total cost was also less with modified ELAPE group compared to conventional ELAPE group (9004 ± 1146 USD vs 10,336 ± 2047 USD, P = 0.031). The incidence of parastomal hernia was less with modified ELAPE group compared to conventional ELAPE group (7/199 vs 22/140, P < 0.001). Three-year follow-up data did not show any difference in overall survival rate or local occurrence between the two groups. Modified ELAPE surgery is technically safe and feasible, and oncologically comparable to that of conventional ELAPE surgery, which can be considered for popularization and application.

Laparoscopic Sugarbaker repair of parastomal hernia following radical cystectomy and ileal conduit: a single-center experience

PurposeParastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit.MethodsWe retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022.ResultsThirty-five patients were included in the study. Median follow up was 32months (IQR, 25–38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery.ConclusionSurgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.

Development of a core descriptor set for parastomal hernia repair.

Parastomal hernia repair is a poorly evidenced area, with uncertainty around the optimum management. There is considerable heterogeneity within the patient cohort, and currently there is no standardization of patient descriptors in the reporting of parastomal hernia repair. The aim of this study was to develop a core descriptor set of key patient characteristics for patients undergoing surgical repair of a parastomal hernia for reporting in all parastomal hernia research. A longlist of descriptors was generated from a review of the existing literature. The longlist was discussed with patients with lived experience of parastomal hernia repair. Colorectal, general and hernia surgeons took part in a three-round international modified Delphi process using a nine-point Likert scale to rank the importance of descriptors. Items meeting predetermined thresholds were included in the final set and discussed and ratified at the consensus meeting. Seventy seven respondents completed round one, with 23 (29.8%) completing round three. Eighty six descriptors were rated across the three rounds, with 52 descriptors shortlisted. The consensus meeting ratified a final core descriptor set with 19 descriptors across eight domains: anatomy, contamination, disease, previous treatment, risk factors, symptoms, pathway and other hernia. The core descriptor set reflects characteristics that are important to surgeons when reporting on parastomal hernia repair. The use of this agreed core descriptor set may aid the reporting of future studies.

An actinomycosis infection resembling peritoneal dissemination of rectal cancer: a case report

BackgroundActinomycosis is a suppurative and granulomatous inflammation commonly caused by Actinomyces israelii. Due to its rarity and the paucity of characteristic clinical features, diagnosis of intra-abdominal actinomycosis is challenging, especially when the patient has a treatment history of abdominal cancer.Case presentationThe patient is a 72-year-old man who has a history of multiple abdominal surgeries for rectal cancer, including low anterior resection for primary rectal cancer, partial hepatic resection for metachronous liver metastasis, and Hartmann surgery for local recurrence. The patient has also undergone parastomal hernia repair using the Sugarbaker method. One year after hernia repair, computed tomography (CT) identified a mass lesion between the abdominal wall and the mesh, suggesting the possibility of peritoneal recurrence of rectal cancer. The accumulation of fluorodeoxyglucose (FDG) was evident via positron emission tomography-CT (PET-CT), while tumor marker levels were within the normal range. On laparotomy, the small intestine, abdominal wall, mesh, colon, and stoma were observed to be associated with the mass lesion, and en bloc resection was carried out. However, postoperative histopathological examination revealed an actinomyces infection without any cancerous cells.ConclusionsThis case highlights the challenges faced by surgeons regarding preoperative diagnosis of actinomycosis, especially when it occurs after the resection of abdominal cancer. Also, this case reminds us of the importance of a histopathological examination for abdominal masses or nodules before starting chemotherapy.

Robotic Pauli repair of parastomal hernia.

Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method. Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket-except PTFE was chosen for inflammatory bowel disease patients. Follow-up was by telephone and physical examination and CT if suspicion of complication. Of the 56 included ostomy patients, 44 had colostomies, 10 had ileostomies, and two had urostomies. Thirty-nine percent had a concomitant hernia, and 25% had recurrent PH. The mean operating time without accessory repair was 156min (SD 37), and with accessory repairs 220min (SD 62). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative stoma revision without postoperative morbidity. Postoperative complications ensued in 12 patients (23%). One patient had stoma necrosis after 3weeks and the stoma was relocated. One patient had a mesh infection, 3 patients temporary ileus, one patient hypovolemic renal failure, and two patients experienced a flare-up of their Crohn's Disease. One parastomal abscess was drained percutaneously. The median postoperative stay was 3days (1-21; mean 3.7days), and the readmission rate was 8.9%. The recurrence rate at mean and median 24months follow-up is 5.4%, two in ileostomy patients and one colostomy patient with unaltered bulging where CT shows a relatively large prolapse and recorded as a failure. Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the preliminary choice for eligible patients at our site. Comparative studies with the intraperitoneal mesh standard are needed.

Robotic parastomal hernia repair: A single-center cohort study.

Parastomal hernia is a common occurrence following stoma construction, necessitating surgical intervention in symptomatic cases. This study presents a comprehensive analysis of Robotic-Assisted Parastomal Hernia Repair (r-PSHR), utilizing the Da Vinci Xi™ Surgical System. Retrospective analysis was conducted on patients undergoing r-PSHR at a high-volume center. Surgical variables, complications, and recurrence rates were assessed. The primary technique involved a modified Sugarbaker intraperitoneal onlay mesh. Eighty-six patients underwent r-PSHR, predominantly females (59.3%), with mean age 60.8years. Mean BMI was 31.0. Most patients were classified as ASA 2 (31.4%) or ASA 3 (65.1), with 64.6% having no prior PSH repair. Index procedures primarily involved laparoscopic colonic resections (27.8%) and open abdominoperineal resections (27.8%). Parastomal hernias were mainly associated with end ileostomy (50%) and end colostomy (47.7%). A hybrid modification was required in 22.1% of cases, with only one conversion to open repair. Mean operative time was 257min. Thirty-day morbidity was 40.7% and includes ileus (24.4%), deep surgical-site infections (7.0%), acute kidney injury (5.8%), and sepsis (5.8%). Grade IIIB complications occurred in 5.8% of cases. Thirty-day readmissions were observed in 19.8% of cases. There were five cases (5.8%) of recurrence within 15months post-surgery. This study highlights the effectiveness of r-PSHR in managing parastomal hernia. R-PSHR shows promising outcomes with an acceptable post-operative occurrence profile and a favorable recurrence rate.

Proof of concept of an experimental prototype for the prevention of parastomal hernia.

The aim of this study was to analyse the complications and problems associated with the use of an experimental prototype designed for the prevention of parastomal hernia (PSH), one of the most frequent complications in ostomates. A single-centre, non-comparative, proof-of-concept interventional pilot study of an experimental prototype designed to be used in conjunction with an abdominal compression binder to prevent PSH was conducted. The "Ostomy Fixation Device for Hernia Prevention" (patent P201531826) is a semi-rigid ostomy protector, to be used in conjunction with a compression binder. It is designed to adapt to the dimensions of standard ostomy bags from different brands and serves to transmit, in a localised manner, the support coming from the compression binder in the peristomal area without putting pressure on the collection bag. The main outcome measures were efficacy, safety, and patient-users' opinion/perception. Ten patients were studied for 12 months. Mean age was 61 years (± 11.59), 70% (7) were male, 80% (8) ostomised for colorectal cancer, 90% (9) underwent planned surgery and 80% (8) had a colostomy. the incidence of HPE was 10% (1). no participant experienced pain, discomfort, itching, stinging, leakage, pouch detachment, allergy to components, or injury to the stoma or peristomal skin due to rubbing or pressure. 90% (n = 9) were considered "very satisfied" or "satisfied" with the device. An innovative device designed in collaboration between healthcare professionals and end-users has been shown to be safe and effective in reducing PSH in the group of ostomates studied.