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

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Abstract

Introduction

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.

Materials and methods

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.

Results

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 39 months (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.

Conclusion

The sandwich technique demonstrated recurrence rates consistent with those reported in the existing literature.

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Authors and Affiliations

  1. Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain

    Alberto G. Barranquero, Yolanda Maestre González, Cristina Gas Ruiz & Rafael Villalobos Mori

  2. Abdominal Wall Unit, General and Digestive Surgery Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain

    Juan José Espert & María Magdalena Llompart Coll

  3. General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain

    Jorge Juan Olsina Kissler

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  1. Alberto G. Barranquero
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Correspondence to Alberto G. Barranquero.

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Alberto G. Barranquero, Juan José Espert, María Magdalena Llompart Coll, Yolanda Maestre González, Cristina Gas Ruiz, Jorge Juan Olsina Kissler, and Rafael Villalobos Mori have no conflicts of interest or financial ties to disclose.

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Barranquero, A.G., Espert, J.J., Llompart Coll, M.M. et al. Analysis of recurrence and risk factors in laparoscopic sandwich technique for parastomal hernia repair. Surg Endosc 37, 9125–9131 (2023). https://doi.org/10.1007/s00464-023-10475-2

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