Robotic Parastomal Hernia Repair: Modified Retromuscular Sugarbaker

Abstract

Parastomal hernias remain technically challenging to repair and continue to have high rates of recurrence and high rates of surgical site occurrences. A variety of operative repairs have been proposed to manage parastomal hernias—each with its own constellation of benefits and clear drawbacks. Repair method is generally selected based on the characteristics of the hernia, the patient comorbidities, and the skill and training level of the surgeon. Methods differ in a variety of ways: open vs. minimally invasive operation, stoma left in situ vs. stoma relocation, primary repair vs. mesh-based repair, permanent synthetic vs. biologic vs. bioabsorbable mesh, uncut vs. keyhole vs. cruciate mesh configuration, and underlay vs. sublay vs. onlay mesh positioning. The need to repair a concomitant midline hernia and the need to include myofascial releases to afford the repair are additional considerations. This chapter describes one method known as the Pauli parastomal henia repair which represents a modified retromuscular Sugarbaker technique.