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Surgical Endoscopy

, Volume 30, Issue 12, pp 5628–5634 | Cite as

Laparoscopic modified Sugarbaker parastomal hernia repair with 2-point anchoring and zigzag tacking of Parietex™ Parastomal Mesh technique

  • Katsuhito SuwaEmail author
  • Shintaro Nakajima
  • Yoshiko Uno
  • Toshiaki Suzuki
  • Shigemasa Sasaki
  • Takuro Ushigome
  • Ken Eto
  • Tomoyoshi Okamoto
  • Katsuhiko Yanaga
Video

Abstract

Background

The ideal mesh and mesh fixation technique for laparoscopic Sugarbaker (SB) parastomal hernia repair have not yet been identified.

Methods

Sixteen patients with parastomal hernia who underwent laparoscopic modified SB repair (LSB) between June 2012 and October 2015 were retrospectively analyzed. LSB was performed using a developed standardized 2-point anchoring and zigzag tacking of Parietex™ Parastomal Mesh (PCO-PM) technique.

Results

Out of 16 cases, 14 were primary and 2 recurrent hernias; 13 were para-end colostomy and 3 were para-ileal conduit (PIC) hernias. The median longitudinal and transverse diameters of the hernia orifice were 5 cm (2.5–7 cm) and 4.2 cm (2–6 cm), respectively. Five cases had a concomitant midline incisional hernia, which was simultaneously repaired. In all cases, the mesh was placed without deflection. The median operation time was 193 (75–386) min. Perioperative complications occurred in two cases (13 %) with PIC, one intra-operatively and the other postoperatively. The intra-operative complication was enterotomy close to the ureteroenteric anastomosis of the ileal conduit; it was repaired through a mini-laparotomy. LSB was accomplished without any subsequent postoperative complications. The postoperative complication was ureteral obstruction that required creation of nephrostomy. Mini-laparotomy was necessary in those two cases (13 %) because of intra-operative enterotomy and severe intra-abdominal adhesions. The median postoperative length of stay was 9 (5–14) days. No recurrence was observed with a median follow-up of 14.5 (2–41) months.

Conclusions

Our LSB using standardized mesh fixation technique is safe and feasible, and the PCO-PM seems to be the most optimal prosthesis.

Keywords

Parastomal hernia Laparoscopic Sugarbaker repair Parietex Zigzag tacking 2-point anchoring 

Notes

Acknowledgments

We gratefully acknowledge and thank Dr. Tomasz Hascilowicz for cooperation in making the video.

Compliance with ethical standards

Disclosures

Authors Katsuhito Suwa, Shintaro Nakajima, Yoshiko Uno, Toshiaki Suzuki, Shigemasa Sasaki, Takuro Ushigome, Ken Eto, Tomoyoshi Okamoto and Katsuhiko Yanaga have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 345125 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Katsuhito Suwa
    • 1
    Email author
  • Shintaro Nakajima
    • 2
  • Yoshiko Uno
    • 2
  • Toshiaki Suzuki
    • 1
  • Shigemasa Sasaki
    • 1
  • Takuro Ushigome
    • 1
  • Ken Eto
    • 2
  • Tomoyoshi Okamoto
    • 1
  • Katsuhiko Yanaga
    • 2
  1. 1.Department of Surgery, Daisan HospitalThe Jikei University School of MedicineKomae-shiJapan
  2. 2.Department of SurgeryThe Jikei University School of MedicineTokyoJapan

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