Laparoscopic modified Sugarbaker parastomal hernia repair with 2-point anchoring and zigzag tacking of Parietex™ Parastomal Mesh technique
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The ideal mesh and mesh fixation technique for laparoscopic Sugarbaker (SB) parastomal hernia repair have not yet been identified.
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.
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.
Our LSB using standardized mesh fixation technique is safe and feasible, and the PCO-PM seems to be the most optimal prosthesis.
KeywordsParastomal hernia Laparoscopic Sugarbaker repair Parietex Zigzag tacking 2-point anchoring
We gratefully acknowledge and thank Dr. Tomasz Hascilowicz for cooperation in making the video.
Compliance with ethical standards
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 1 (WMV 345125 kb)
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