Robotic Parastomal Hernia

  • Peter A. Walker
  • Shinil K. Shah


Parastomal hernias are a common complication of operations requiring fecal or urinary diversion with an incidence approaching 50%. Patients with parastomal hernias can experience issues with obstruction, pain, and decreased functional mobility often necessitating operative repair. The review of the available literature suggests that the laparoscopic modified Sugarbaker repair offers improved recurrence rates with decreased wound complications as compared with open approaches. However, only approximately 10% of hernias are repaired via minimally invasive techniques. Robotic platforms offer increased degrees of freedom and could potentially decrease the learning curve for laparoscopic repair. We review the available literature and discuss the technique required for robotic-assisted laparoscopic parastomal hernia repair.


Parastomal Hernia Robotic Laparoscopic Sugarbaker Stoma 


  1. 1.
    Leslie D. The parastomal hernia. Surg Clin North Am. 1984;64(2):507–15.CrossRefGoogle Scholar
  2. 2.
    Pearl RK. Parastomal hernias. World J Surg. 1989;13(5):569–72.CrossRefGoogle Scholar
  3. 3.
    Hotouras A, Murphy J, Thaha M, Chan CL. The persistent challenge of parastomal herniation: a review of the literature and future developments. Color Dis. 2013;15(5):e202–14.CrossRefGoogle Scholar
  4. 4.
    Liu NW, Hackney JT, Gellhaus PT, Monn MF, et al. Incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and ileal conduit diversion. J Urol. 2014;191(5):1313–8.CrossRefGoogle Scholar
  5. 5.
    Van Dijk SM, Timmermans L, Deerenberg EB, Lamme B, et al. Parastomal hernia: impact on quality of life? World J Surg. 2015;39(10):2595–601.CrossRefGoogle Scholar
  6. 6.
    Sohn YJ, Moon SM, Shin US, Jee SH. Incidence and risk factors of parastomal hernia. J Korean Soc Coloproctol. 2012;28(5):241–6.CrossRefGoogle Scholar
  7. 7.
    Donahue TF, Bochner BH, Sfakianos JP, Kent M. Risk factors for the development of parastomal hernia after radical cystectomy. J Urol. 2014;191(6):1708–13.CrossRefGoogle Scholar
  8. 8.
    Temple B, Farley T, Popik K, Ewanyshyn C, et al. Prevalance of parastomal hernia and factors associated with its development. J Wound Ostomy Continence Nurs. 2016;43(5):489–93.CrossRefGoogle Scholar
  9. 9.
    Al Shakarachi J, Williams JG. Systemic review of open techniques for parastomal hernia repair. Tech Coloproctol. 2014;18(5):427–32.CrossRefGoogle Scholar
  10. 10.
    Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, et al. Surgical techniques for parastomal hernia repair: a systemic review of literature. Ann Surg. 2012;255(4):685–95.CrossRefGoogle Scholar
  11. 11.
    Franks ME, Hrebinko RL Jr. Technique of parastomal hernia repair using synthetic mesh. Urology. 2001;57(3):551–3.CrossRefGoogle Scholar
  12. 12.
    Kasperk R, Klinge U, Schumpelick V. The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg. 2000;179(3):186–8.CrossRefGoogle Scholar
  13. 13.
    Steele SR, Lee P, Martin MJ, Mullenix PS, et al. Is parastomal hernia repair with polypropylene mesh safe? Am J Surg. 2003;185(5):436–40.CrossRefGoogle Scholar
  14. 14.
    Stelzner S, Hellmich G, Ludwig K. Repair of paracolostomy hernias with a prosthetic mesh in the intraperitoneal onlay position: modified Sugarbaker technique. Dis Colon Rectum. 2004;47(2):185–91.CrossRefGoogle Scholar
  15. 15.
    Rubin MS, Schoetz DJ Jr, Matthews JB. Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg. 1994;129(4):413–8.CrossRefGoogle Scholar
  16. 16.
    Riansuwan W, Hull TL, Millan MM, Hammel JP. Surgery of recurrent parastomal hernia: direct repair of relocation? Color Dis. 2010;12(7):681–6.CrossRefGoogle Scholar
  17. 17.
    Pekmezci S, Memisoqlu K, Karahasanoglu T, Alemdaroglu K. Laparoscopic giant parastomal hernia repair with prosthetic mesh. Tech Coloproctol. 2002;6(3):187–90.CrossRefGoogle Scholar
  18. 18.
    Halabi WJ, Jafari MD, Carmichael JC, Nguyen VQ, et al. Laparoscopic versus open repair of parastomal hernias: an ACS-NSQIP anaylsis of short term data. Surg Endosc. 2013;27(11):4067–72.CrossRefGoogle Scholar
  19. 19.
    Mizrahi H, Bhattacharya P, Parker MC. Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results. Surg Endosc. 2012;26(1):267–70.CrossRefGoogle Scholar
  20. 20.
    Hasnsson BM, Bleichrodt RP, de Hingh IH. Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate. Surg Endosc. 2009;23(7):1456–9.CrossRefGoogle Scholar
  21. 21.
    Hansson BM, Morales-Conde S, Mussack T, Valdes J, et al. The laparoscopic modified Sugarbaker technique is safe and has a low recurrence rate: a multicenter cohort trial. Surg Endosc. 2013;27(2):494–500.CrossRefGoogle Scholar
  22. 22.
    DeAsis FJ, Lapin B, Gitelis ME, Ujiki MB. Current state of laparoscopic parastomal hernia repair: a meta-analysis. World J Gastroenterol. 2015;21(28):8670–7.CrossRefGoogle Scholar
  23. 23.
    Gogenur I, Mortensen J, Harvald T, Rosenberg J, et al. Prevention of parastomal hernia by placement of a polypropylene mesh at primary operation. Dis Colon Rectum. 2006;49(8):1131–5.CrossRefGoogle Scholar
  24. 24.
    Pianka F, Probst P, Keller AV, Saure D, et al. Prophylactic mesh placement for the PREvention of paraSTOmal hernias: the PRESTO systemic review and meta-analysis. PLoS One. 2017;12(2):e0171548.CrossRefGoogle Scholar
  25. 25.
    Wijeyekoon SP, Gurusamy K, El-Gendy K, Chan CL. Prevention of parastomal hernia with biologic/composite mesh: a systemic review and meta-analysis of randomized controlled trials. J Am Coll Surg. 2010;211(5):637–45.CrossRefGoogle Scholar
  26. 26.
    Patel SV, Zhang L, Chadi SA, Wexner SD. Prophylactic mesh to prevent parastomal hernia: a meta-analysis of randomized controlled studies. Tech Coloproctol. 2017;21(1):5–13.CrossRefGoogle Scholar
  27. 27.
    Allison N, Tieu K, Snyder B, Pigazzi A, et al. Technical feasibility of robot-assisted ventral hernia repair. World J Surg. 2012;36(2):447–52.CrossRefGoogle Scholar
  28. 28.
    Gonzalez A, Escobar E, Romero R, Walker G, et al. Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes. Surg Endosc. 2017;31(3):1342–9.CrossRefGoogle Scholar
  29. 29.
    Nardi M Jr, Millo P, Brachet Contul R, et al. Laparoscopic ventral hernia repair with composite mesh: analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg. 2017;40:38–44.CrossRefGoogle Scholar
  30. 30.
    Liang MK, Holihan JL, Itani K, et al. Ventral hernia management: expert consensus guided by systematic review. Ann Surg. 2017;265(1):80–9.CrossRefGoogle Scholar
  31. 31.
    Pernar LI, Pernar CH, Dieffenbach BV, Brooks DC, Smink DS, Tavakkoli A. What is the BMI threshold for open ventral hernia repair? Surg Endosc. 2017;31(3):1311–7.CrossRefGoogle Scholar
  32. 32.
    Tandon A, Pathak S, Lyons NJ, Nunes QM, et al. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg. 2016;103(12):1598–607.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Peter A. Walker
    • 1
  • Shinil K. Shah
    • 1
    • 2
  1. 1.Department of Surgery, McGovern Medical School, University of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M UniversityCollege StationUSA

Personalised recommendations