Technique Of Parastomal Hernia Repair Research Articles

Early outcomes of robotic modified retromuscular Sugarbaker technique for end colostomy parastomal hernia repair.

The modified retromuscular Sugarbaker or Pauli technique is a technique for parastomal hernia repair, which requires the dissection of the retromuscular space and a transversus abdominis release for stoma lateralization and placement of a retromuscular mesh. Given the limited evidence regarding the robotic approach to this technique, this study aims to evaluate the outcomes of this newly introduced procedure, focusing on the rate of 30-day complications and recurrence rates. Retrospective case series report. Patients included underwent an elective robotic modified retromuscular Sugarbaker technique for the repair of a parastomal hernia associated with an end colostomy. All surgeries were performed at a tertiary referral center from September 2020 to December 2023. A total of 21 patients underwent a robotic modified retromuscular Sugarbaker in our study. The parastomal hernias operated on were classified according to the European Hernia Society as 9.5% (2/21) type I, 52.4% (11/21) type II, 23.8% (5/21) type III, 14.3% (3/21) type IV. Early complications observed included 14.3% (3/21) seroma, 9.5% (2/21) surgical site infection, 19% (4/21) postoperative ileus, and one case of large bowel obstruction due to colitis (4.8%), which was managed conservatively. No Clavien-Dindo grade III complications were reported. The overall recurrence rate was 9.5% (2/21) with a median follow-up of 12.5 months (IQR: 3.9-21.3). Both recurrences occurred during the early phases of the learning curve and were possibly attributed to insufficient lateralization of the stoma. Robotic modified retromuscular Sugarbaker for parastomal hernia repair is a challenging procedure with promising early outcomes.

Robotic modified Sugarbaker technique for parastomal hernia repair: a standardized approach.

Parastomal hernia (PSH) is a prevalent long-term morbidity associated with stoma construction, and the optimal operative management remains uncertain. This study addresses the need for a standardized approach to symptomatic PSH repair, focusing on the robotic-assisted modified Sugarbaker technique with composite permanent mesh. The study, conducted in a high-volume colon and rectal surgery referral practice, outlines a systematic approach to patient selection, surgical procedures, and postoperative care. Preoperative evaluations include detailed medical and surgical histories, impact assessments of PSH, and oncological history reviews. The surgical technique involves the Da Vinci Xi™ robotic platform for adhesiolysis, hernia content reduction, stoma revision if needed, narrowing of the enlarged stoma trephine, lateralization of the stoma limb of bowel, and securing the mesh to the abdominal wall. Outcomes are reported for 102 patients undergoing robotic parastomal hernia repair from January 2021 to July 2023. Conversion to open surgery occurred in only one case (0.9%). Postoperative complications affected 39.2% of patients, with ileus being the most frequent (24.5%). Recurrence was observed in 5.8% of cases during an average follow-up of 10 months. In conclusion, parastomal hernia, a common complication post-stoma creation, demands surgical intervention. The robotic-assisted modified Sugarbaker repair technique, as outlined in this paper, offers promising results in terms of feasibility and outcomes.

Analysis of recurrence and risk factors in laparoscopic sandwich technique for parastomal hernia repair.

Parastomal hernias are frequent and highly recurrent. The sandwich technique is a combination of the keyhole and Sugarbaker techniques, using a double intraperitoneal mesh. The objective of this study was to assess the outcomes of the sandwich technique, specifically focusing on recurrence rates. Observational retrospective study conducted in two tertiary referral centers in Catalonia, Spain. All consecutive patients who underwent parastomal hernia repair using the sandwich technique between 1st January 2016 and 31st December 2021 were included. A total of 38 patients underwent the laparoscopic sandwich technique for parastomal hernia repair. The overall recurrence rate was 7.9% (3/38), with a median follow-up of 39months (IQR: 12.3-56.5). According to the EHS classification for parastomal hernia, there were 47.4% (18/38) type I defects, 10.5% (4/38) type II defects, 28.9% (11/38) type III defects, and 13.2% (5/38) type IV defects. The used mesh was predominantly TiMesh® (76.3%; 29/38), followed by DynaMesh® IPOM (23.7%; 9/38). Patients with recurrence exhibited higher rates of seroma, hematoma, surgical site infection, and one case of early recurrence attributed to mesh retraction. Consequently, postoperative complications emerged as the primary risk factor for hernia recurrence. The sandwich technique demonstrated recurrence rates consistent with those reported in the existing literature.

Hybrid Sugarbaker technique for parastomal hernia repair (with video).

Hybrid Sugarbaker technique for parastomal hernia repair (with video).

Comparing Sugarbaker versus keyhole mesh technique for open retromuscular parastomal hernia repair: study protocol for a registry-based randomized controlled trial

BackgroundParastomal hernia, common after stoma creation, negatively impacts patient quality of life. For patients with a permanent stoma, durable parastomal hernia repair remains a challenge, with few high-quality studies for guidance. An alternative to open retromuscular parastomal hernia repair with retromuscular “keyhole” mesh is the recent Sugarbaker modification. We aim to compare these two techniques in a head-to-head prospective study.MethodsThis is a registry-based randomized controlled trial designed to investigate whether the retromuscular Sugarbaker technique is superior to the retromuscular keyhole technique for parastomal hernia repair. The primary study endpoint is parastomal hernia recurrence at 2 years. Secondary endpoints include hospital length-of-stay, readmission, wound morbidity, mesh-related complications, re-operation, all 30-day morbidity, and patient-reported outcomes, including hernia-related quality of life, stoma-specific quality of life, pain, and decision regret.DiscussionBased on the post hoc analysis of a recent randomized controlled trial, we hypothesize that the retromuscular Sugarbaker technique will reduce parastomal hernia recurrence by 20% at 2 years compared to the retromuscular keyhole mesh technique. The results of this study may provide evidence-based guidance for surgeons repairing parastomal hernias.Trial registrationClinicalTrials.gov NCT03972553. Registered on 3 June 2019

Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a randomised controlled trial

BackgroundParastomal hernia is a common complication of an enterostomy and can have a significant impact on health-related quality of life. Currently used methods of repair have high recurrence rates and considerable risk for complications. We have developed a new technique for parastomal hernia repair that uses full-thickness skin graft as reinforcement.MethodsThis study protocol describes a multicentre randomised controlled trial on parastomal hernia repair comparing a new full-thickness skin graft technique with conventional synthetic composite mesh as reinforcement of the abdominal wall. Patients with a symptomatic parastomal hernia will be included and followed up at 3, 12 and 36 months, with surgical complication as the primary outcome. Secondary outcomes will be recurrence rate and health-related quality of life assessed with VHPQ, EORTC C30 and CR29. Tissue biology and collagen metabolism will be investigated pre- and postoperatively using biopsies of the abdominal wall fascia and blood samples.DiscussionParastomal hernia constitutes a major clinical problem where the prospects of a good result after hernia repair are presently poor. This new method of repair with full-thickness skin grafting could be a new alternative in our surgical toolbox, but before then, it must be evaluated properly.Trial registrationClinicalTrials.gov NCT03667287. Registered on September 12, 2018

Single center experience with the modified retromuscular Sugarbaker technique for parastomal hernia repair.

Parastomal hernias are challenging to manage, and an optimal repair has yet to be defined. An open, modified, retromuscular Sugarbaker technique has recently been described in the literature as a technically feasible approach to parastomal hernia repair. This study evaluates our initial institutional experience with parastomal hernia repair with the aforementioned technique with respect to safety and durability. All patients who underwent an open, modified retromuscular Sugarbaker parastomal hernia repair from 2014 through 2016 at our institution were identified. Patient characteristics, hernia variables, operative details, and 30-day and medium-term outcomes were abstracted from the Americas Hernia Society Quality Collaborative database. Outcomes of interest included 30-day wound morbidity, mesh-related complications, and hernia recurrence. Thirty-eight patients met inclusion criteria. 20 (53%) patients presented to our institution for management of a recurrent parastomal hernia. 35 (92%) patients had a concurrent midline incisional hernia with a mean total hernia width of 15.1cm and mean defect size of 353cm2. Thirty-day wound morbidity rate was 13%. At a mean of follow-up of 13months (range 4-30), the hernia recurrence rate was 11%. Three patients (8%) experienced mesh erosion into the stoma bowel, leading to stoma necrosis, bowel obstruction, and/or perforation which required reoperation at day 8, 12, and 120days, respectively. The outcomes of the retromuscular Sugarbaker technique for the management of parastomal hernias have been disappointing at our institution, with a concerning rate of serious mesh-related complications. This operation, as originally described, needs further study before widespread adoption with a particular focus on the technique of mesh placement, the most appropriate mesh selection, and the long-term rate of mesh erosion.

If the clinical experience is very important for everyday practice….

Editorial comments on the leading article: New minimally invasive technique of parastomal hernia repair – methods and review M. Szczepkowski, P. Skoneczny, A. Przywozka, P. Czyzewski, K. Bury Prof. Marek Szczepkowski is the head of the Department of General and Colorectal Surgery of Bielanski Hospital in Warsaw, one of the most experienced surgical departments in parastomal hernia repair in Poland. Several surgical techniques of parastomal hernia repair have been described. Currently, the Sugarbaker technique, described in 1980, and the sandwich technique, which was first described by Berger, are the most common for surgical repair [1, 2]. The laparoscopic approach to parastomal hernia repair seems to be superior to the open approach due to its lower rate of recurrence and lower rate of postoperative complications, and this method was suggested by Hansson et al. [3]. Laparoscopy in other hernia repair regions has been advocated for many times by numerous surgeons, including in the pages of Videosurgery, and it was extremely encouraging that the Hybrid Operation was used by a team of Prof. Szczepkowski in parastomal hernia repair [4, 5]. Polish surgeons’ contribution to the development of this very difficult field of hernia repair surgery is very visible. The classification currently in force and suggested by the European Hernia Society (EHS) takes into account the experience of the center which is headed by Prof. Szczepkowski [6, 7]. From this center there have been published several papers concerning the experience of Bielanski Hospital. During the consensus meeting on Parastomal Hernia Repair in Gdansk in 2011, the Working Group of Polish specialists in this domain was established. The goal of this group was to give a recommendation and the proper approach to this surgical problem, which is very difficult to resolve. This consensus was published in the Polish Journal of Surgery as a contribution to further discussion and studies and is still the indicator for many surgeons [8]. This original paper presents a prospective single center and single surgeon study which shows early results of the novel concept of the minimally invasive surgical technique of parastomal hernia repair – the HyPER technique (Hybrid Parastomal Endoscopic Re-do). It also contains a short review of the most popular methods of resolving this difficult surgical problem. This technique consists of three main parts: the initial, laparoscopic part (adhesiolysis of the region of the ostomy and hernia sac; the next part – open technique (excision of stoma and hernia sac, intraperitoneal placement of special, dedicated for parastomal hernia intraperitoneal on-lay mesh (IPOM) with a funnel and creation of a new stoma with narrowing of the hernia orifice); and the third part – a return to laparoscopy with fixation of this special mesh to the abdominal wall by tacks. According to the initial results this new technique is very promising because it combines the advantages of the open and laparoscopic approach. The authors believe that factors such as narrowing the fascia aperture and removal of the hernia sac have greatly attributed to reduction of the recurrence rate of parastomal hernia. Another important factor is adequate mesh selection. Nevertheless, further studies need to be conducted to confirm this thesis in the context of a large group of patients and long-term follow-up.

New minimally invasive technique of parastomal hernia repair - methods and review.

IntroductionParastomal hernia is described as the most common complication in patients with ostomy. It is reported that its incidence varies from 3% to 39% for colostomies and 0 to 6% for ileostomies. Surgical repair remains the treatment of choice. There are three types of surgical treatment – fascial repair, stoma relocation and repair using prosthetic mesh via a laparoscopic or open approach. Recently there have been several meta-analyses and systematic reviews aiming to compare the results of surgical treatment, and the authors agreed that the quality of evidence precludes firm conclusions.AimTo describe the novel concept of parastomal hernia repair – HyPER/SPHR technique (hybrid parastomal endoscopic re-do/Szczepkowski parastomal hernia repair) and its early results in 12 consecutive cases.Material and methodsTwelve consecutive patients were operated on due to parastomal hernia using the new HyPER hybrid technique between June 2013 and May 2014. The patients’ condition was evaluated during the perioperative period, 6 weeks and then every 3 months after surgery.ResultsAfter 6 weeks of follow-up we have not observed any mesh-related complications. All 12 patients were examined 3 months and 6 months after repair surgery for evaluation. No recurrence, stoma site infection or stoma-related problems were found. None of the patients complained of pain and none of them needed to be hospitalized again. Reported quality of life on a 0–10 scale after 6 weeks of follow-up was 8 (range: 7–10).ConclusionsThe HyPER procedure for treatment of parastomal hernias proposed by the authors is a safe and feasible surgical technique with a high patient satisfaction rate and a low number of complications. The hybrid procedure seems to be a promising method for parastomal hernia repair.

Parastomal hernias successfully repaired using a modified components separation method: two case reports

IntroductionParastomal hernia is a frequent complication after enterostomy formation. A repair using prosthetic mesh by way of a laparoscopic or open transabdominal approach is usually recommended, however, other procedures may be done if the repair is to be performed in a contaminated environment or when the abdominal cavity of the patient is difficult to enter due to postsurgical dense adhesion. The components separation method, which was introduced for non-transabdominal and non-prosthetic ventral hernia repair, solves such problems.Case presentationCase 1. A 79-year-old Japanese woman who underwent total cystectomy with ileal conduit for bladder cancer presented with a parastomal hernia, which was repaired using a keyhole technique. Simultaneously, an incisional hernia in the midline was repaired with a prosthetic mesh. One year after her hernia surgery, a recurrence occurred lateral to the stoma, but it was believed to be difficult to enter the peritoneal cavity because of the wide placement of mesh. Therefore, surgery using the components separation method was performed.Case 2. A 72-year-old Japanese man underwent an abdominoperineal resection for rectal cancer. At 5 and 12 months after his operation, a perineal hernia and an incisional hernia in the midline were repaired with prosthesis using a transabdominal approach, respectively. Three years after his rectal surgery, a parastomal hernia developed lateral to the stoma. For the same reason as case 1, surgery using the components separation method was performed. No recurrence was observed in either case as of 40 and 8 months after the last repair, respectively.ConclusionThe components separation method is a novel and effective technique for parastomal hernia repair, especially in cases following abdominal polysurgery or midline incisional hernia repairs using large pieces of mesh. To the best of our knowledge, this is the first report in English on the application of the components separation method for parastomal hernia repair.

Modified technique for parastomal hernia repair in patients with intractable stoma‐care problems

Although stoma relocation is generally the first choice of treatment for parastomal hernia, a repair using polypropylene prosthetic mesh is sometimes employed in cases of parastomal hernia recurrence. Use of this mesh, however, has been associated with a high risk of bowel erosion, adhesions formation, and fistulization. We therefore began to use expanded polytetrafluoroethylene (ePTFE) mesh to perform an onlay parastomal hernia repair. Our initial clinical experience with this procedure is described. Sixteen patients aged 39-70 years with intractable stoma problems underwent a modified intra-abdominal onlay technique with implantation of a large (26 x 36 cm) sheet of ePTFE mesh. During a median follow-up of 29 months (range, 5-52 months), no mesh-related bowel erosion, fistulization, or adhesion formation were observed. Two patients had a recurrence of the hernia due to technical failure. Re-operation in one of these resulted in wound dehiscence and removal of the contaminated mesh. Another patient developed intestinal obstruction postoperatively. The mesh was removed, and a gastrointestinal stromal tumour was found. Finally, a nonmesh related small bowel erosion required removal of the mesh in one patient. All other patients had full relief of symptoms. The modified onlay technique using a large sheet of ePTFE prosthetic mesh is a feasible option for treatment of parastomal hernia recurrence. Possible advantages of the procedure include stoma preservation, strengthening of the abdominal wall, and a reduced risk of recurrence, contamination, fistulization, and bowel adhesions and erosion.

Technique of parastomal hernia repair using synthetic mesh

We describe a reliable and simple technique of parastomal hernia repair using primary fascial repair with synthetic mesh that minimizes the known complications of infection and stomal stenosis while eliminating the need for peritoneal exploration, lysis of adhesions, and relocation of the stoma. We applied this technique to 6 patients (aged 65 to 83 years) with symptomatic, first-time parastomal hernias. The results are discussed.

Intraparietal mesh repair for parastomal hernias

Herniation is a common long-term complication after a permanent stoma and the classical non-prosthetic repairs have a high recurrence rate. This type of hernia should be considered as incisional, so a prosthetic-based repair seems to be the best choice; nevertheless, the need for another laparotomy and the ideal plane to place the mesh remain debatable. We describe our initial experience with a novel technique for parastomal hernia repair that combines mesh 1 reinforcement with a local approach, thus avoiding a laparotomy. The anatomic disposition of the rectus sheath allows us to place a wide mesh in an intraparietal/anteromuscular plane, avoiding direct contact with the intestine and providing a reinforced wall. After 13 months of follow-up (3–20 months) our 3 patients have excellent results.