Abstract
Background
Parastomal hernia (PH) is a frequent complication of stoma formation, occurring in 35–50 % of patients. Recurrence after repair is common, ranging from 24 to 54 % of cases. We hypothesized that repair using a laparoscopic modified Sugarbaker technique (SB) would result in a superior recurrence rate when compared with other repairs.
Methods
An Institutional Review Board-approved retrospective review of patients who underwent PH repair between 2004 and 2011 was performed. We collected demographics, factors related to ostomy formation, risk factors for hernia, intraoperative and postoperative information, as well as the absence or presence of PH on their last physical examination or imaging study.
Results
Forty-nine PH repairs were performed: 33 (67 %) para-ileostomy and 16 (33 %) para-colostomy. Repairs included 14 laparoscopic modified SB, 19 laparoscopic keyhole, 11 ostomy re-sitings, and 5 open primary repairs. There was no statistically significant difference between groups when comparing age, BMI, smoking status, steroid use, ostomy type, location, primary diagnoses, or complication rate. Recurrence rates were 0 % for SB, 58 % for keyhole, 64 % for re-siting, and 20 % for open repair. When SB was compared with all groups, the incidence of recurrence was significantly lower (p < 0.001) but follow-up was as well (7.2 vs 32.7 months). When analysis was restricted to the 28 repairs performed between 2009 and 2011, there was no significant difference between the groups in terms of demographics or follow-up period (7.2 months for SB group versus 11.8 months for all others), but again there was a significant difference in recurrence (0 of 14 for the SB group vs 8 of 14, p < 0.01). In addition, there were no differences in postoperative complication rates among all techniques.
Conclusion
The modified SB technique may offer patients a significant decrease in the risk of recurrence compared with other PH repair techniques with no significant increase in postoperative complications.
Similar content being viewed by others
References
Craft R, Harold K (2009) Laparoscopic repair of incisional and other complex abdominal well hernias. Permanente J 13(3):38–42
Pearl RK (1989) Parastomal hernias. World J Surg 13:569
De Raet J, Delvaux G, Haentjens P, Van Nieuwenhove Y (2008) Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 51:1806
Safadi B (2004) Laparoscopic repair of parastomal hernia: early results. Surg Endosc 18:676–680
Rosin JD, Bonardi RA (1997) Paracolostomy hernia repair with Marlex mesh: a new technique. Dis Colon Rectum 20(4):299–302
Berger D (2002) Laparoscopic paraostomal hernia repair: indications, technique and results. In: Morales-Conde S (ed) Laparoscopic ventral hernia repair. Springer-Verlag, France, pp 383–387
Sugarbaker Ph (1980) Prosthetic mesh repair of large hernia at the site of colonic stomas. Surg Gynecol Obstet 150:576–578
Sugarbaker Ph (1985) Peritoneal approach to prosthetic mesh repair of paracolostomy hernias. Ann Surg 201:344–346
Mancini GJ, McClusky DA, Khaitan L et al (2007) Laparoscopic parastomal hernia repair using a non-slit mesh technique. Surg Endosc 21:1487–1491
Stelzner S, Hellmich G, Ludwig K (2004) Repair of paracolostomy hernia with a prosthetic mesh in the intraperitoneal only position: modified Sugarbaker technique. Dis Colon Rectum 47:185–191
Muysoms F, Hauters Ph, Nieuwenhove Y et al (2008) Laparoscopic repair of parastomal hernias: a multi-centre retrospective review and shift in technique. Acta Chir Belg 108:400–404
Voeller G (2001) Repair of incisional hernias and midlines defects. In: Bendavid R, Abrahamson J, Arregui M, Flament J, Phillips E (eds) Abdominal wall hernias: principles and management. Springer-Verlag, New York, pp 516–526
LeBlanc KA, Bellanger DE (2002) Laparoscopic repair of parastomy hernias: early results. J Am Coll Surg 194:232–239
Muysoms F (2007) Laparoscopic repair of parastomal hernias with a modified Sugarbaker technique. Acta Chir Belg 107:476–480
Mirza B, Chand B (2008) Laparoscopic repair of ileal conduit parastomal hernia using the sling technique. JSLS 12:173–179
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Asif, A., Ruiz, M., Yetasook, A. et al. Laparoscopic modified Sugarbaker technique results in superior recurrence rate. Surg Endosc 26, 3430–3434 (2012). https://doi.org/10.1007/s00464-012-2358-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2358-5