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Journal of Robotic Surgery

, Volume 13, Issue 3, pp 483–489 | Cite as

Robotic retro-rectus repair of parastomal hernias

  • Victor MacielEmail author
  • Wilmer Mata
  • Gabriel Arevalo
  • Marianna Zeichen
  • Timothy Glass
Original Article
  • 136 Downloads

Abstract

Objective

To present our technique of robotic retrorectus parastomal hernia repair.

Background

Parastomal hernias represent a significant problem with high recurrence and long-term complications. An estimated of 120,000 new stomas are created per year with a prevalence of up to 800,000 patients in the U.S. 40–60% of these ostomies will never be reversed. Parastomal hernias cause skin breakdown and make adherence of ostomy appliances difficult, creating the need for frequent bag exchanges. They can also cause pain, bowel obstruction and bowel incarceration or strangulation. All of these factors affect quality of life and represent a significant burden to our health care system. There is no definitive gold-standard technique to repair parastomal hernias. The use of prosthesis decreases the recurrence rates, yet using prosthetic material can result in long-term complications. Surgeons have developed techniques of pre-peritoneal mesh placement to provide long-lasting repairs and at the same time prevent complications associated with the mesh. We believe that a robotic retro-rectus approach provides a secure repair and avoids leaving prosthetic material in the abdominal cavity at the same time.

Methods

A three-arm technique is used, inserting ports opposite to the target anatomy. Hernia contents are reduced protecting the ostomy loop and mesentery. The contralateral retro-rectus space is entered and this space is developed extensively across the midline and around the ostomy. The hernia defect is approximated. Concomitant ventral hernias are also repaired. A polypropylene mesh with a keyhole is used and wide coverage is ensured in all directions. The leaflets of the mesh are stitched together and the mesh is sutured to the abdominal wall. Finally, the retro-rectus space is closed.

Results

We have performed this technique in two patients safely and at 1-year follow-up there were no recurrences in either. On conclusion, this is a novel minimally invasive technique to repair parastomal hernias that provides wide coverage of the defect and avoids leaving mesh intraperitoneally.

Keywords

Robotic Parastomal hernia Peristomal hernia Hernia Retrorectus Sublay Keyhole 

Notes

Acknowledgements

The authors of this paper thank Dr. Tim Glass for his support to our surgical education and his mentorship, leading us with his example to become surgical innovators.

Compliance with ethical standards

Conflict of interest

Drs. Maciel, Mata, Arevalo and Zeichen have no disclosures. Dr. Glass is a proctor for Intuitive Surgical.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee.

Informed consent

Informed consent was obtained from all individual participants included in this article.

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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Broward Surgical SpecialistsTamaracUSA
  2. 2.St. Vincent Hospital Surgery Department and General Surgery Residency programIndianapolisUSA
  3. 3.Indiana University General Surgery Residency ProgramIndianapolisUSA

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