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Matarazzo F, Genovese A, Giuliani G, Guerra F, Coratti A. Step-by-step robotic parastomal hernia repair with retromuscular mesh (Pauli technique): A video vignette. Colorectal Dis 2024. [PMID: 39256905 DOI: 10.1111/codi.17168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/03/2024] [Indexed: 09/12/2024]
Affiliation(s)
- Francesco Matarazzo
- Department of General and Urgent Surgery, USL Toscana Sud Est, Misericordia Hospital, School of Robotic Surgery, Grosseto, Italy
| | - Alfredo Genovese
- Department of General and Urgent Surgery, USL Toscana Sud Est, Misericordia Hospital, School of Robotic Surgery, Grosseto, Italy
| | - Giuseppe Giuliani
- Department of General and Urgent Surgery, USL Toscana Sud Est, Misericordia Hospital, School of Robotic Surgery, Grosseto, Italy
| | - Francesco Guerra
- Department of General and Urgent Surgery, USL Toscana Sud Est, Misericordia Hospital, School of Robotic Surgery, Grosseto, Italy
| | - Andrea Coratti
- Department of General and Urgent Surgery, USL Toscana Sud Est, Misericordia Hospital, School of Robotic Surgery, Grosseto, Italy
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Lambrecht JR. Robotic Pauli repair of parastomal hernia. Surg Endosc 2024:10.1007/s00464-024-11223-w. [PMID: 39225795 DOI: 10.1007/s00464-024-11223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method. METHODS Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket-except PTFE was chosen for inflammatory bowel disease patients. Follow-up was by telephone and physical examination and CT if suspicion of complication. RESULTS Of the 56 included ostomy patients, 44 had colostomies, 10 had ileostomies, and two had urostomies. Thirty-nine percent had a concomitant hernia, and 25% had recurrent PH. The mean operating time without accessory repair was 156 min (SD 37), and with accessory repairs 220 min (SD 62). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative stoma revision without postoperative morbidity. Postoperative complications ensued in 12 patients (23%). One patient had stoma necrosis after 3 weeks and the stoma was relocated. One patient had a mesh infection, 3 patients temporary ileus, one patient hypovolemic renal failure, and two patients experienced a flare-up of their Crohn's Disease. One parastomal abscess was drained percutaneously. The median postoperative stay was 3 days (1-21; mean 3.7 days), and the readmission rate was 8.9%. The recurrence rate at mean and median 24 months follow-up is 5.4%, two in ileostomy patients and one colostomy patient with unaltered bulging where CT shows a relatively large prolapse and recorded as a failure. CONCLUSION Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the preliminary choice for eligible patients at our site. Comparative studies with the intraperitoneal mesh standard are needed.
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Affiliation(s)
- Jan Roland Lambrecht
- Department of Gastroenterological Surgery, Sykehuset Innlandet Hospital Trust, Furnesvegen 26, N-2380, Brumunddal, Norway.
- , Hunnsvegen 54, N2819, Gjoevik, Norway.
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Maskal SM, Ellis RC, Fafaj A, Costanzo A, Thomas JD, Prabhu AS, Krpata DM, Beffa LRA, Tu C, Zheng X, Miller BT, Rosen MJ, Petro CC. Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair: A Randomized Clinical Trial. JAMA Surg 2024; 159:982-989. [PMID: 38865142 PMCID: PMC11170450 DOI: 10.1001/jamasurg.2024.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 06/13/2024]
Abstract
Importance Durable parastomal hernia repair remains elusive. There is limited evidence comparing the durability of the open retromuscular Sugarbaker and keyhole mesh configurations. Objective To determine if the open retromuscular Sugarbaker mesh placement technique would lower parastomal hernia recurrence rates. Design, Setting, and Participants In this single-center, randomized clinical trial, 150 patients with a permanent stoma and associated parastomal hernia who were candidates for open retromuscular parastomal hernia repair were enrolled and randomized from April 2019 to April 2022 and followed up for 2 years. Interventions Following intraoperative assessment to determine the feasibility of either technique, enrolled patients were randomized to receive either retromuscular Sugarbaker or keyhole synthetic mesh placement. Main Outcomes and Measures The primary outcome was parastomal hernia recurrence at 2 years. Secondary outcomes included mesh-related complications, wound complications, reoperations, as well as patient-reported pain, abdominal wall-specific quality of life, stoma-specific quality of life, and decision regret at 1 year and 2 years. Results A total of 150 patients were randomized, and with 91% follow-up at 2 years, there were 13 (17%) parastomal hernia recurrences in the retromuscular Sugarbaker arm and 18 (24%) in the keyhole arm (adjusted risk difference, -0.029; 95% CI, -0.17 to 0.153, and adjusted risk ratio, 0.87; 95% CI, 0.42 to 1.69). There were no statistically significant differences between the Sugarbaker and keyhole groups regarding reoperations for recurrence (2 vs 7, respectively), nonhernia intra-abdominal pathology (4 vs 10, respectively), stoma necrosis (1 vs 0, respectively), mesh-related complications (4 vs 1, respectively), patient-reported pain, abdominal wall-specific quality of life, stoma-specific quality of life, and decision regret at any time point. Conclusions and Relevance In the setting of open parastomal hernia repair, a retromuscular Sugarbaker mesh placement technique was not superior to a keyhole configuration 2 years after repair. Further innovation is necessary to improve parastomal hernia repair outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03972553.
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Affiliation(s)
- Sara M Maskal
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ryan C Ellis
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Aldo Fafaj
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Adele Costanzo
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jonah D Thomas
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Ajita S Prabhu
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David M Krpata
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Chao Tu
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
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Fleming AM, Wood EH. Repair of Parastomal Hernias. Adv Surg 2024; 58:107-119. [PMID: 39089771 DOI: 10.1016/j.yasu.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Parastomal hernias are an inevitable consequence of ostomy formation and their repairs remain a challenge to many surgeons. With multiple systems of classification and a multitude of techniques for hernia repair ranging from suture to mesh repair, the literature remains sparse with regards to the optimal method of repair. The authors describe the most commonly adopted techniques, discuss preventative measures, and review the current literature in the context of perioperative outcomes and hernia recurrence.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Avenue Room 329, Memphis, TN 38103, USA
| | - Elizabeth H Wood
- Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Avenue Room 329, Memphis, TN 38103, USA.
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5
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Barranquero AG, Maestre González Y, Gas Ruiz C, Sadurni Gracia M, Olsina Kissler JJ, Villalobos Mori R. Early outcomes of robotic modified retromuscular Sugarbaker technique for end colostomy parastomal hernia repair. Hernia 2024:10.1007/s10029-024-03152-3. [PMID: 39212762 DOI: 10.1007/s10029-024-03152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
AIM The modified retromuscular Sugarbaker or Pauli technique is a technique for parastomal hernia repair, which requires the dissection of the retromuscular space and a transversus abdominis release for stoma lateralization and placement of a retromuscular mesh. Given the limited evidence regarding the robotic approach to this technique, this study aims to evaluate the outcomes of this newly introduced procedure, focusing on the rate of 30-day complications and recurrence rates. METHODS Retrospective case series report. Patients included underwent an elective robotic modified retromuscular Sugarbaker technique for the repair of a parastomal hernia associated with an end colostomy. All surgeries were performed at a tertiary referral center from September 2020 to December 2023. RESULTS A total of 21 patients underwent a robotic modified retromuscular Sugarbaker in our study. The parastomal hernias operated on were classified according to the European Hernia Society as 9.5% (2/21) type I, 52.4% (11/21) type II, 23.8% (5/21) type III, 14.3% (3/21) type IV. Early complications observed included 14.3% (3/21) seroma, 9.5% (2/21) surgical site infection, 19% (4/21) postoperative ileus, and one case of large bowel obstruction due to colitis (4.8%), which was managed conservatively. No Clavien-Dindo grade III complications were reported. The overall recurrence rate was 9.5% (2/21) with a median follow-up of 12.5 months (IQR: 3.9-21.3). Both recurrences occurred during the early phases of the learning curve and were possibly attributed to insufficient lateralization of the stoma. CONCLUSION Robotic modified retromuscular Sugarbaker for parastomal hernia repair is a challenging procedure with promising early outcomes.
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Affiliation(s)
- Alberto G Barranquero
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida, 25198, Catalonia, Spain.
| | - Yolanda Maestre González
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida, 25198, Catalonia, Spain
| | - Cristina Gas Ruiz
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida, 25198, Catalonia, Spain
| | - Marta Sadurni Gracia
- General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Rafael Villalobos Mori
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida, 25198, Catalonia, Spain
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Szczepkowski M, Zamkowski M, Alicja S, Piotr W, Śmietański M. Evaluating EHS parastomal hernia classification for surgical planning: a retrospective analysis of 160 consecutive cases in a single center. Hernia 2024:10.1007/s10029-024-03121-w. [PMID: 39123085 DOI: 10.1007/s10029-024-03121-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Parastomal hernia (PH) is a prevalent complication following ostomy formation, presenting significant challenges in surgical management. This study aims to validate the European Hernia Society classification for PH through the application of the Hybrid Parastomal Endoscopic Repair (HyPER) method. The study focuses on establishing the practical utility of the European Hernia Society classification in a clinical setting, particularly in guiding surgical approaches and improving patient outcomes. MATERIALS AND METHODS This retrospective observational study aimed to assess the utility of the European Hernia Society classification in planning surgical strategies for parastomal hernias. The validation of the classification of PH was based on the experience involving 160 patients in single center. Patients were classified according to the European Hernia Society criteria, and data were collected on patient demographics, clinical presentations, and surgical outcomes. Main goal was to assess the consistency and applicability of the European Hernia Society classification in predicting surgical challenges and outcomes. RESULTS The study found a predominance of complex Type III and IV hernias. The European Hernia Society classification was effective in categorizing PH, aiding in surgical planning and highlighting the increased complication rates associated with more complex hernia types. This study represents the largest single-center cohort treated for PH by a single team, providing a controlled evaluation of the HyPER technique's effectiveness. CONCLUSIONS The validation of the European Hernia Society classification in this study is a significant advancement in the standardization of PH management. The findings demonstrate the classification's utility in enhancing surgical planning and patient-centered care. The study also opens avenues for further research into standardized approaches and techniques in PH treatment.
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Affiliation(s)
- Marek Szczepkowski
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education in Warsaw, Bielanski Hospital, Warsaw, Poland
| | - Mateusz Zamkowski
- Swissmed Hospital, Department of General Surgery and Hernia Center, Wileńska 44, Gdańsk, 80- 215, Poland.
| | - Suwała Alicja
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education in Warsaw, Bielanski Hospital, Warsaw, Poland
| | - Witkowski Piotr
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education in Warsaw, Bielanski Hospital, Warsaw, Poland
| | - Maciej Śmietański
- Swissmed Hospital, Department of General Surgery and Hernia Center, Wileńska 44, Gdańsk, 80- 215, Poland
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Renard Y, Romain B. Robotic-assisted parastomal hernia repair using a modified Pauli technique (with video). J Visc Surg 2024:S1878-7886(24)00098-5. [PMID: 39127516 DOI: 10.1016/j.jviscsurg.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Yohann Renard
- Department of Digestive Surgery, Reims university Hospital, Reims, France
| | - Benoît Romain
- Department of Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France.
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Parker SG, Blake H, Halligan S, Ishak A, Mahrous H, Abdelgelil M, Windsor ACJ, Shanmuganandan A, Jakkalasaibaba R, Thomas R. Anatomical Variation of Abdominal Wall Musculature: An Objective Assessment Using Cross-Sectional Imaging. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:13114. [PMID: 38974808 PMCID: PMC11224142 DOI: 10.3389/jaws.2024.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024]
Abstract
Purpose: To determine normal anatomical variation of abdominal wall musculature. Methods: A retrospective analysis of CT scans was performed on adults (>18 years) with normal abdominal wall muscles. Two radiologists analysed the images independently. Distances from three fixed points in the midline were measured. The fixed points were; P1, mid-way between xiphoid and umbilicus, P2, at the umbilicus, and P3, mid-way between umbilicus and pubic symphysis. From these three fixed points the following measurements were recorded; midline to lateral innermost border of the abdominal wall musculature, midline to lateral edge of rectus abdominis muscle, and midline to medial edges of all three lateral abdominal wall muscles. To obtain aponeurotic width, rectus abdominis width was subtracted from the distance to medial edge of lateral abdominal wall muscle. Results: Fifty normal CT scan were evaluated from between March 2023 to August 2023. Mean width of external oblique aponeurosis at P1 was 16.2 mm (IQR 9.2 mm to 20.7 mm), at P2 was 23.5 mm (IQR 14 mm to 33 mm), and at P3 no external oblique muscle was visible. Mean width of the internal oblique aponeurosis at P1 was 32.1 mm (IQR 17.5 mm to 45 mm), at P2 was 10.13 (IQR 1 mm to 17.5 mm), and at P3 was 9.2 mm (IQR 3.0 mm to 13.7 mm). Mean width of the transversus abdominis aponeurosis at P1 was -25.1 mm (IQR 37.8 mm to -15.0 mm), at P2 was 29.4 mm (IQR 20 mm to 39.8 mm), and at P3 was 20.3 mm (IQR 12 mm to 29 mm). Conclusion: In this study we describe normal anatomical variation of the abdominal wall muscles. Assessing this variability on the pre-operative CT scans of ventral hernia patients allows for detailed operative planning and decision making.
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Affiliation(s)
| | - Helena Blake
- The Abdominal Wall Unit, Croydon University Hospital, London, United Kingdom
| | - Steve Halligan
- University College London Centre of Medical Imaging, London, United Kingdom
| | - Athanasius Ishak
- The Abdominal Wall Unit, Croydon University Hospital, London, United Kingdom
| | - Hossam Mahrous
- The Abdominal Wall Unit, Croydon University Hospital, London, United Kingdom
| | - Mohammed Abdelgelil
- The Abdominal Wall Unit, Croydon University Hospital, London, United Kingdom
| | | | - Arun Shanmuganandan
- The Abdominal Wall Unit, Croydon University Hospital, London, United Kingdom
| | | | - Rhys Thomas
- The Abdominal Wall Unit, Croydon University Hospital, London, United Kingdom
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Riediger H, Köckerling F. Limitations of Transversus Abdominis Release (TAR)-Additional Bridging of the Posterior Layer And/Or Anterior Fascia Is the Preferred Solution in Our Clinical Routine If Primary Closure is Not Possible. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12780. [PMID: 38952417 PMCID: PMC11215005 DOI: 10.3389/jaws.2024.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024]
Abstract
Background: By separating the abdominal wall, transversus abdominis release (TAR) permits reconstruction of the abdominal wall and the placement of large mesh for many types of hernias. However, in borderline cases, the mobility of the layers is inadequate, and additional bridging techniques may be required for tension-free closure. We now present our own data in this regard. Patients and Methods: In 2023, we performed transversus abdominis release on 50 patients as part of hernia repair. The procedures were carried out using open (n = 25), robotic (n = 24), and laparoscopic (n = 1) techniques. The hernia sac was always integrated into the anterior suture and, in the case of medial hernias, was used for linea alba reconstruction. Results: For medial hernias, open TAR was performed in 22 cases. Additional posterior bridging was performed in 7 of these cases. The ratio of mesh size in the TAR plane to the defect area (median in cm) was 1200cm2/177 cm2 = 6.8 in patients without bridging, and 1750cm2/452 cm2 = 3.8 in those with bridging. The duration of surgery (median in min) was 139 and 222 min and the hospital stay was 6 and 10 days, respectively. Robotic TAR was performed predominantly for lateral and parastomal hernias. These procedures took a median of 143 and 242 min, and the hospital stay was 2 and 3 days, respectively. For robotic repair, posterior bridging was performed in 3 cases. Discussion: Using the TAR technique, even complex hernias can be safely repaired. Additional posterior bridging provides a reliable separation of the posterior plane from the intestines. Therefore, the hernia sac is always available for anterior reconstruction of the linea alba. The technique can be implemented as an open or minimally invasive procedure.
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Romain B, Villemin A, Suciu S, Brigand C, Rohr S, Manfredelli S. Parastomal hernia repair according to Modified Stapled Mesh Stoma Reinforcement Technique (mSMART): which are the results ? Hernia 2024; 28:883-886. [PMID: 38607609 DOI: 10.1007/s10029-024-03005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/23/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Parastomal hernia repair is a real surgical challenge because of the high rate of recurrence. The Stapled Mesh Stoma Reinforcement Technique (SMART) is a keyhole-like technique in which the mesh is stapled to the fascia using a circular mechanical stapler. METHODS A prospective study from January 2021 to February 2023 was conducted including all patients operated with the SMART technique. Primary endpoint was the recurrence rate during the follow-up. Secondary endpoints were reoperation, Surgical site Occurrence (SSO) and deep (mesh) surgical site infection (SSI) within 30 days postoperatively. RESULTS Sixteen patients operated on SMART procedures were included. The mean follow-up was 11.3 ± 9.2 months. The SSO rate was 18.7% (n = 3). A seroma was drained radiologically (IIIa), one haematoma was evacuated surgically (IIIb) and one patient presented a postoperative lesion of a ureter after a parastomal Bricker's hernia repair. In addition, there was one death due to multiple organ failure (V). There was no SSI. The recurrence rate was 57.1% during the follow-up. CONCLUSION This study shows disappointing results for this SMART technique, with a high recurrence rate.
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Affiliation(s)
- B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France.
| | - A Villemin
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - S Suciu
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
| | - S Manfredelli
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200, Strasbourg, France
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Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LRA, Costanzo A, Zheng X, Rosenblatt S, Rosen MJ, Petro CC. Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial. Surgery 2024; 175:813-821. [PMID: 37770344 DOI: 10.1016/j.surg.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/14/2023] [Accepted: 06/18/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Open parastomal hernia repair can be performed using retromuscular synthetic mesh in a keyhole or Sugarbaker configuration. Relative morbidity and durability are unknown. Here, we present perioperative outcomes of a randomized controlled trial comparing these techniques, including 30-day patient-reported outcomes, reoperations, and wound complications in ≤90 days. METHODS This single-center randomized clinical trial compared open parastomal hernia repair with retromuscular medium-weight polypropylene mesh in the keyhole and Sugarbaker configuration for permanent stomas between April 2019 and April 2022. Adult patients with parastomal hernias requiring open repair with sufficient bowel length for either technique were included. Patient-reported outcomes were collected at 30 days; 90-day outcomes included initial hospital length of stay, readmission, wound morbidity, reoperation, and mesh- or stoma-related complications. RESULTS A total of 150 patients were randomized (75 keyhole and 75 Sugarbaker). There were no differences in length of stay, readmission, reoperation, recurrence, or wound complications. Twenty-four patients (16%) required procedural intervention for wound morbidity. Ten patients (6.7%) required abdominal reoperation in ≤90 days, 7 (4.7%) for wound morbidity, including 3 partial mesh excisions (1 keyhole compared with 2 Sugarbaker; P = 1). Four mesh-related stoma complications requiring reoperations occurred, including stoma necrosis (n = 1), bowel obstruction (n = 1), parastomal recurrence (n = 1), and mucocutaneous separation (n = 1), all in the Sugarbaker arm (P = .12). Patient-reported outcomes were similar between groups at 30 days. CONCLUSION Open parastomal hernia repair with retromuscular mesh in the keyhole and Sugarbaker configurations had similar perioperative outcomes. Patients will be followed to determine long-term relative durability, which is critical to understanding each approach's risk-benefit ratio.
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Affiliation(s)
- Sara M Maskal
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | | | | | - Aldo Fafaj
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | | | | | - Ryan C Ellis
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | - Ajita S Prabhu
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/aprabhumd1
| | - David M Krpata
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/DKrpataMD
| | - Lucas R A Beffa
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/BeffaLukeMD
| | | | | | | | - Michael J Rosen
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/MikeRosen
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Parker SG, Blake H, Zhao S, van Dellen J, Mohamed S, Albadry W, Akhtar H, Franczak B, Jakkalasaibaba R, Rothnie A, Thomas R. An established abdominal wall multidisciplinary team improves patient care and aids surgical decision making with complex ventral hernia patients. Ann R Coll Surg Engl 2024; 106:29-35. [PMID: 36927113 PMCID: PMC10757872 DOI: 10.1308/rcsann.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Abdominal wall reconstruction (AWR) is an emerging subspecialty within general surgery. The practice of multidisciplinary team (MDT) meetings to aid decision making and improve patient care has been demonstrated, with widespread acceptance. This study presents our initial experience of over 150 cases of complex hernia patients discussed in a newly established MDT setting. METHODS From February 2020 to July 2022 (30-month period), abdominal wall MDTs were held bimonthly. Key stakeholders included upper and lower gastrointestinal surgeons, a gastrointestinal specialist radiologist, a plastic surgeon, a high-risk anaesthetist and two junior doctors integrated into the AWR clinical team. Meetings were held online, where patient history, past medical and surgical history, hernia characteristics and up-to-date computed tomography scans were discussed. RESULTS Some 156 patients were discussed over 18 meetings within the above period. Ninety-five (61%) patients were recommended for surgery, and 61 (39%) patients were recommended for conservative management or referred elsewhere. Seventy-eight (82%) patients were directly waitlisted, whereas seventeen (18%) required preoperative optimisation: three (18%) for smoking cessation, eleven (65%) for weight-loss management and three (18%) for specialist diabetic assessment and management. In total, 92 (59%) patients (including operative and nonoperative management) have been discharged to primary care. DISCUSSION A multidisciplinary forum for complex abdominal wall patients is a safe process that facilitates decision making, promotes education and improves patient care. As the AWR subspecialty evolves, our view is that the "complex hernia MDT" will become commonplace. We present our experience and share advice for others planning to establish an AWR centre.
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Affiliation(s)
- SG Parker
- Croydon Health Services NHS Trust, UK
| | - H Blake
- Croydon Health Services NHS Trust, UK
| | - S Zhao
- Croydon Health Services NHS Trust, UK
| | | | - S Mohamed
- Croydon Health Services NHS Trust, UK
| | - W Albadry
- St George’s University Hospitals NHS Foundation Trust, UK
| | - H Akhtar
- Croydon Health Services NHS Trust, UK
| | | | | | - A Rothnie
- Croydon Health Services NHS Trust, UK
| | - R Thomas
- Croydon Health Services NHS Trust, UK
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Bloemendaal ALA. Robotic Retromuscular (Recurrent) Parastomal Hernia Repair (r-Pauli-Repair) With Synthetically Reinforced Biological Mesh; Technique, Early Experience, and Short-Term Follow-Up. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:12059. [PMID: 38312416 PMCID: PMC10831679 DOI: 10.3389/jaws.2023.12059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/30/2023] [Indexed: 02/06/2024]
Abstract
Introduction: Parastomal hernia repair remains a challenge. We describe a robotic retromuscular non-keyhole mesh repair using a synthetically reinforced biological mesh (Ovitex) for the repair of complex and/or recurrent parastomal hernia and technical modifications we made along the way to improve our technique. Methods: All patients underwent the described retromuscular parastomal hernia repair. Data was collected in a database and a retrospective analysis was performed on direct postoperative results and early follow-up. Results: Eleven patients underwent the operation. Median follow-up was 12 months. Median LOS was 6 days. Two recurrences occurred. One patient suffered postoperative hematoma and skin necrosis, which healed completely, but did lead to a recurrence. One patient had a significant seroma, which subsided without intervention. Both recurrences were reoperated, and a local repair was performed. Conclusion: This paper is the first to describe a modified robotic Pauli repair for complex and recurrent parastomal hernia, using a synthetically reinforced biological mesh. Results are satisfying so far, especially considering the complexity of the cases.
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14
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Cardenas Lara FJ, Cima RR. Robotic-assisted parastomal hernia repair using the Sugarbaker technique. Colorectal Dis 2023; 25:2460-2461. [PMID: 37872877 DOI: 10.1111/codi.16779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/11/2023] [Indexed: 10/25/2023]
Affiliation(s)
| | - Robert R Cima
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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15
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Barranquero AG, Espert JJ, Llompart Coll MM, Maestre González Y, Gas Ruiz C, Olsina Kissler JJ, Villalobos Mori R. Analysis of recurrence and risk factors in laparoscopic sandwich technique for parastomal hernia repair. Surg Endosc 2023; 37:9125-9131. [PMID: 37814164 DOI: 10.1007/s00464-023-10475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
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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Affiliation(s)
- Alberto G Barranquero
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain.
| | - Juan José Espert
- Abdominal Wall Unit, General and Digestive Surgery Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - María Magdalena Llompart Coll
- Abdominal Wall Unit, General and Digestive Surgery Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Yolanda Maestre González
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
| | - Cristina Gas Ruiz
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
| | - Jorge Juan Olsina Kissler
- General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Rafael Villalobos Mori
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
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16
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Rendell VR, Pauli EM. Parastomal Hernia Repair. Surg Clin North Am 2023; 103:993-1010. [PMID: 37709401 DOI: 10.1016/j.suc.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Parastomal hernias (PHs) are common and contribute to significant patient morbidity. Despite 45 years of evolution, mesh-based PH repairs continue to be challenging to perform and remain associated with high rates of postoperative complications and recurrences. In this article, the authors summarize the critical factors to consider when evaluating a patient for PH repair. The authors provide an overview of the current techniques for repair, including both open and minimally invasive approaches. The authors detail the mesh-based repair options and review the evidence for choice of mesh to use for repair.
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Affiliation(s)
- Victoria R Rendell
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
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17
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Bellido-Luque J, Bellido-Luque A, Gomez-Rosado JC, Gomez-Menchero J, Suarez-Grau JM, Licardie E, Tejada-Gomez A, Navarro-Morales L, Moreno-Suero F, Sanchez-Matamoros I, Capitán-Morales L, Nogales Muñoz A, Morales-Conde S. Full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach for para-colostomy hernia repair: Technical aspects and 2-year follow-up results of a prospective cohort. Colorectal Dis 2023; 25:2033-2042. [PMID: 37712246 DOI: 10.1111/codi.16734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 09/16/2023]
Abstract
AIM This study aimed to assess technical aspects and clinical results of a new minimally invasive technique in parastomal hernia (PSH) repair, full endoscopic retromuscular access, after 2 years of follow-up. METHODS Data from consecutive patients requiring minimally invasive ventral PSH repair were collected from 2019 to 2022. The inclusion criteria were patients aged between 18 and 80 years old with symptomatic PSH. Demographics and perioperative and postoperative data were collected. Postoperative pain and functional recovery were compared with preoperative data. RESULTS Twelve patients with symptomatic PSH were included. The mean PSH defect area was 16.2 cm2 and the mean midline defect was 8.7 cm2 . No intra-operative complications or conversion to open surgery were detected. One patient (8%) required postoperative readmission due to partial bowel obstruction symptoms that required catheterization of the stoma. Pain significantly worsened after the first postoperative day compared to preoperative data but improved after the first postoperative month compared to the first postoperative week and after the 90th postoperative day compared to the first postoperative month, with significant differences. Significant restriction improvement was identified when 30 days after surgery data were compared to preoperative data and when the 180th postoperative day results were compared to 30 days after surgery. The average follow-up was 29 months. During the follow-up no clinical or radiological recurrence was observed. CONCLUSION This paper shows low rate of intra- and postoperative complications with significant improvement in terms of pain activities restriction compared to preoperatory. After 29 months follow-up, no recurrence was identified, confirming that this approach offers good mid-term results.
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Affiliation(s)
- Juan Bellido-Luque
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
- Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | | | | | - Julio Gomez-Menchero
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | | | - Eugenio Licardie
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | - Antonio Tejada-Gomez
- Minimally Invasive Surgery, QuironSalud Sagrado Corazón Hospital, Seville, Spain
| | | | | | | | | | - Angel Nogales Muñoz
- Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain
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18
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Mazzola Poli de Figueiredo S, Rodrigues ACLF, de Araújo SW, Mao RMD, Villasante-Tezanos A, Tastaldi L, Lu R. Keyhole Versus Sugarbaker Mesh Configuration in Parastomal Hernia Repair: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2023; 33:556-564. [PMID: 37523583 DOI: 10.1097/sle.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Parastomal hernia repairs (PHRs) are often complex and challenging, even for experienced abdominal wall surgeons. Although the ideal therapeutic option in the setting of a parastomal hernia is to restore intestinal continuity, this is often not feasible, and numerous techniques have been described for PHR. Current guidelines recommend using mesh for elective PHR, but there is a scarcity of evidence comparing different PHR techniques. We aimed to report a meta-analysis comparing the outcomes of the "Sugarbaker" and "Keyhole" mesh configuration in PHR. METHODS A literature search of PubMed, Embase, Scopus, and Cochrane Library databases was performed to identify studies comparing Sugarbaker and Keyhole mesh configuration in PHR. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS A total of 3247 studies were screened, and 27 were fully reviewed. Ten studies and 632 patients were included in the meta-analysis. Three hundred five patients (48.3%) with Keyhole and 327 patients (51.7%) with Sugarbaker mesh configuration. Four hundred thirty-three patients (68.5%) underwent laparoscopic PHR with intraperitoneal onlay mesh. Sugarbaker mesh configuration was associated with lower hernia recurrence compared with Keyhole (odds ratio: 0.39; 95% CI: 0.19-0.83; P = 0.01; I2 = 46%). No differences were seen in overall complications, reoperations, stoma outlet obstruction, mesh infection, and postoperative bleeding. CONCLUSION PHR with Sugarbaker mesh configuration is associated with decreased hernia recurrence compared with Keyhole and had similar rates of overall complications, reoperations, stoma outlet obstruction, mesh infection, and postoperative bleeding.
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19
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Köhler F, Meir M. [67/f-Bulging around the stoma : Preparation for the medical specialist examination: part 35]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:35-38. [PMID: 37389639 DOI: 10.1007/s00104-023-01915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/01/2023]
Affiliation(s)
- F Köhler
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
| | - Michael Meir
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland
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20
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Bel N, Blanc PY, Moszkowicz D, Kim B, Deballon PO, Berrada D, Liu D, Romain B, Ophélie D, Renard Y, Passot G. Surgical management of parastomal hernia following radical cystectomy and ileal conduit: A french multi-institutional experience. Langenbecks Arch Surg 2023; 408:344. [PMID: 37642752 DOI: 10.1007/s00423-023-03062-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Parastomal incisional hernia (PH) is a frequent complication following the creation of an ileal conduit (IC), and it can be a significant detriment to quality of life. The aim of this study was to evaluate outcomes of PH repair following IC for urinary diversion. METHOD A multicenter retrospective study was conducted of 6 academic hospitals in France. The study's population included patients who underwent surgical treatment for parastomal hernia following IC creation from 2013 to 2021. RESULTS Fifty-one patients were included in the study. Median follow up was 15.3 months. Eighteen patients presented with a recurrence (35%), with a median time to recurrence of 11.1 months. The vast majority of PH repair was performed through an open approach (88%). With regard to technique, Keyhole was the most reported technique (46%) followed by Sugarbaker (22%) and suture only (20%). The Keyhole technique was associated with a higher risk of recurrence compared to the Sugarbaker technique (52% vs 10%, p = 0.046). Overall, there was a 7.8% rate of major complications without a statistical difference between PH repair techniques for major complications. CONCLUSION Surgical treatment of parastomal hernia following IC was associated with a high risk of recurrence. Novel surgical approaches to PH repair should be considered.
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Affiliation(s)
- Nicolas Bel
- Hospices Civils de Lyon, Service de Chirurgie Viscérale Et Oncologique, Hôpital Lyon Sud Pierre Bénite, Pierre-Bénite, France
| | - Pierre-Yves Blanc
- Service de Chirurgie Générale Et d'Urgences, CHU de Dijon - Université de Bourgogne, Bourgogne, France
| | - David Moszkowicz
- Service de Chirurgie Générale Et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université Paris Cité, 92700, Colombes, France
| | - Bradford Kim
- Department of Surgery Division of Surgical Oncology, Duarte, CA, USA
| | - Pablo Ortega Deballon
- Service de Chirurgie Générale Et d'Urgences, CHU de Dijon - Université de Bourgogne, Bourgogne, France
| | - Delia Berrada
- Université Lyon1, Faculté de Médecine Et de Maïeutique Charles Mérieux, Oullins, France
| | - David Liu
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Et Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, 67200, Strasbourg, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Et Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, 67200, Strasbourg, France
| | - Delchet Ophélie
- Department of Urology, Robert Debre University Hospital, University of Reims Champagne-Ardennes, Rue Cognac Jay, 51100, Reims, France
| | - Yohann Renard
- Department of Digestive Surgery, University of Reims Champagne-Ardennes, Robert Debre University Hospital, Rue Cognac Jay, 51100, Reims, France
| | - Guillaume Passot
- CICLY, Hôpital Lyon Sud Pierre Bénite, Université Lyon1, Et Hospices Civils de Lyon, Service de Chirurgie Viscérale Et Oncologique, Pierre-Bénite, France.
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21
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Valle de Lersundi AR, López-Monclús J, Blázquez Hernando LA, Muñoz Rodriguez J, Medina Pedrique M, Avilés Oliveros A, Morejón Ruiz S, García-Ureña MA. Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study. Cir Esp 2023; 101 Suppl 1:S40-S45. [PMID: 38042592 DOI: 10.1016/j.cireng.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 12/04/2023]
Abstract
Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.
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Affiliation(s)
| | - Javier López-Monclús
- Servicio de Cirugía General, Hospital Universitario Puerta de Hierro, C. Joaquín Rodrigo, 1, 28222 Majadahonda, Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- Servicio de Cirugía General, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034 Madrid, Spain
| | - Joaquin Muñoz Rodriguez
- Servicio de Cirugía General, Hospital Universitario Puerta de Hierro, C. Joaquín Rodrigo, 1, 28222 Majadahonda, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Adriana Avilés Oliveros
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Sara Morejón Ruiz
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
| | - Miguel-Angel García-Ureña
- Servicio de Cirugía General, Hospital Universitario del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain
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22
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Zolin SJ, Krpata DM, Petro CC, Prabhu AS, Rosenblatt S, Rosen S, Thompson R, Fafaj A, Thomas JD, Huang LC, Rosen MJ. Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients. Ann Surg 2023; 277:e900-e906. [PMID: 35793810 DOI: 10.1097/sla.0000000000005443] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to report long-term clinical and patient-reported outcomes of transversus abdominis release (TAR) with permanent synthetic mesh performed in a high-volume abdominal wall reconstruction practice. SUMMARY BACKGROUND DATA Despite increasing utilization of TAR in abdominal wall reconstruction, long-term clinical and patient-reported outcomes remain uncertain. METHODS Prospectively collected registry data from the Cleveland Clinic Center for Abdominal Core Health were analyzed retrospectively. Patients undergoing elective, open VHR with TAR and permanent synthetic mesh implantation between August 2014 and March 2020 with 30-day clinical and ≥1 year clinical or patient-reported outcome follow-up were included. Outcomes included composite hernia recurrence, characterized by patient-reported bulges and recurrent hernias noted on physical exam or imaging, as well as hernia-specific quality of life and pain. RESULTS A total of 1203 patients were included. Median age was 60 years [interquartile range (IQR): 52-67], median body mass index was 32 kg/m 2 (IQR: 28-36), median hernia width was 15 cm (IQR: 12-19), and 57% of hernias were recurrent. Fascial reapproximation was achieved in 92%. At a median follow-up of 2 years (IQR: 1-4), the overall composite hernia recurrence rate was 26%, with sensitivity analysis yielding best-case and worst-case estimates of 5% and 28%, respectively. Patients experienced improved hernia-specific quality of life and pain regardless of recurrence outcome; however, those who did not recur experienced more substantial improvement. CONCLUSIONS TAR with permanent synthetic mesh remains a valuable, versatile technique; however, surgeon and patient expectations should be tempered regarding long-term durability. Despite a high rate of recurrence, patients experience measurable improvements in quality of life.
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Affiliation(s)
- Samuel J Zolin
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Clayton C Petro
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Samantha Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Reid Thompson
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Jonah D Thomas
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
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23
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Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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24
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Dewulf M, Dietz UA, Montgomery A, Pauli EM, Marturano MN, Ayuso SA, Augenstein VA, Lambrecht JR, Köhler G, Keller N, Wiegering A, Muysoms F. Robotic hernia surgery IV. English version : Robotic parastomal hernia repair. Video report and preliminary results. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:129-140. [PMID: 36480037 PMCID: PMC9747841 DOI: 10.1007/s00104-022-01779-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 12/14/2022]
Abstract
The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of a funnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing a comprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition.
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Affiliation(s)
- Maxime Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, Olten, Switzerland
| | | | - Eric M Pauli
- Department of Surgery, Division of Minimally Invasive and Bariatric, PennState Hershey Medical Center, Hershey, PA, USA
| | - Matthew N Marturano
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Jan R Lambrecht
- Department of Surgery, Sykehuset Innlandet Hospital Trust, Brumunddal, Norway
| | - Gernot Köhler
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | - Nicola Keller
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduer. Str. 6, 97080, Wuerzburg, Germany.
| | - Filip Muysoms
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
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25
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Dewulf M, Dietz UA, Montgomery A, Pauli EM, Marturano MN, Ayuso SA, Augenstein VA, Lambrecht JR, Köhler G, Keller N, Wiegering A, Muysoms F. [Robotic hernia surgery IV. German version : Robotic parastomal hernia repair. Video report and preliminary results]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:1051-1062. [PMID: 36214850 PMCID: PMC9592664 DOI: 10.1007/s00104-022-01715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/24/2023]
Abstract
The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of a funnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing a comprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition.
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Affiliation(s)
- Maxime Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, Niederlande
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, Olten, Schweiz
| | | | - Eric M Pauli
- Department of Surgery, Division of Minimally Invasive & Bariatric, PennState Hershey Medical Center, Hershey, PA, USA
| | - Matthew N Marturano
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Jan R Lambrecht
- Department of Surgery, Sykehuset Innlandet Hospital Trust, Brumunddal, Norwegen
| | - Gernot Köhler
- Department of Surgery, Ordensklinikum Linz, Linz, Österreich
| | - Nicola Keller
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Schweiz
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduer. Str. 6, 97080, Wuerzburg, Deutschland.
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Ghent, Belgien.
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Invited Commentary: Two Hundred Twenty-Nine Years to Get It Right. J Am Coll Surg 2022; 235:409-410. [PMID: 35972158 DOI: 10.1097/xcs.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Biologic vs Synthetic Mesh for Parastomal Hernia Repair: Post Hoc Analysis of a Multicenter Randomized Controlled Trial. J Am Coll Surg 2022; 235:401-409. [PMID: 35588504 DOI: 10.1097/xcs.0000000000000275] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parastomal hernias are often repaired with mesh to reduce recurrences, but the presence of an ostomy increases the wound class from clean to clean-contaminated/contaminated and makes the choice of mesh more controversial than in a strictly clean case. We aimed to compare the outcomes of biologic and synthetic mesh for parastomal hernia repair. STUDY DESIGN This is a post hoc analysis of parastomal hernia repairs in a randomized trial comparing biologic and synthetic mesh in contaminated ventral hernia repairs. Outcomes included rates of surgical site occurrences requiring procedural intervention (SSOPI), reoperations, stoma/mesh-related adverse events, parastomal hernia recurrence rates (clinical, patient-reported, and radiographic) at 2 years, quality of life (EQ-5D, EQ-5D Visual Analog Scale, and Hernia-Related Quality of Life Survey), and hospital costs up to 30 days. RESULTS A total of 108 patients underwent parastomal hernia repair (57 biologic (53%) and 51 synthetic (47%)). Demographic and hernia characteristics were similar between the two groups. No significant differences in SSOPI rates or reoperations were observed between mesh types. Four mesh erosions into an ostomy requiring reoperations (2 biologic vs 2 synthetic) occurred. At 2 years, parastomal hernia recurrence rates were similar for biologic and synthetic mesh (17 (29.8%) vs 13 (25.5%), respectively; P=.77). Overall and hernia-related quality of life improved from baseline and were similar between the two groups at 2 years. Median total hospital cost and median mesh cost were higher for biologic compared to synthetic mesh. CONCLUSION Biologic and synthetic mesh have similar wound morbidity, reoperations, 2-year hernia recurrence rates, and quality of life in parastomal hernia repairs. Cost should be considered in mesh choice for parastomal hernia repairs.
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Miller BT, Thomas JD, Tu C, Costanzo A, Beffa LRA, Krpata DM, Prabhu AS, Rosen MJ, Petro CC. Comparing Sugarbaker versus keyhole mesh technique for open retromuscular parastomal hernia repair: study protocol for a registry-based randomized controlled trial. Trials 2022; 23:251. [PMID: 35379311 PMCID: PMC8978433 DOI: 10.1186/s13063-022-06207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background Parastomal hernia, common after stoma creation, negatively impacts patient quality of life. For patients with a permanent stoma, durable parastomal hernia repair remains a challenge, with few high-quality studies for guidance. An alternative to open retromuscular parastomal hernia repair with retromuscular “keyhole” mesh is the recent Sugarbaker modification. We aim to compare these two techniques in a head-to-head prospective study. Methods This is a registry-based randomized controlled trial designed to investigate whether the retromuscular Sugarbaker technique is superior to the retromuscular keyhole technique for parastomal hernia repair. The primary study endpoint is parastomal hernia recurrence at 2 years. Secondary endpoints include hospital length-of-stay, readmission, wound morbidity, mesh-related complications, re-operation, all 30-day morbidity, and patient-reported outcomes, including hernia-related quality of life, stoma-specific quality of life, pain, and decision regret. Discussion Based on the post hoc analysis of a recent randomized controlled trial, we hypothesize that the retromuscular Sugarbaker technique will reduce parastomal hernia recurrence by 20% at 2 years compared to the retromuscular keyhole mesh technique. The results of this study may provide evidence-based guidance for surgeons repairing parastomal hernias. Trial registration ClinicalTrials.gov NCT03972553. Registered on 3 June 2019
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Suwa K, Ushigome T, Enomoto H, Tsukazaki Y, Takeuchi N, Okamoto T, Eto K. Feasibility of using a tailored mesh in laparoscopic Sugarbaker parastomal hernia repair. Asian J Endosc Surg 2022; 15:344-351. [PMID: 34958170 DOI: 10.1111/ases.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In parastomal hernia (PH) repair, laparoscopic Sugarbaker technique (LS) is considered the best practice; however, meshes specific for LS repairs ceased to be available. PURPOSE The aim of the study was to evaluate feasibility of using a physician-modified mesh (tailored mesh: TM) in LS. METHODS Thirty-three patients who underwent LS for PH between June 2012 and September 2021 were examined to compare surgical outcomes between LS with TM (n = 11) and with a ready-made specific mesh (SM, n = 22). All meshes were coated plastic meshes. Statistical analysis was performed with the Mann-Whitney U test and Fisher's exact test. P < .05 was considered to be statistically significant. RESULTS We compared the outcomes of TM with SM in LS for similar hernia types during median follow-up periods of 23 (range, 2-29) and 74 (range, 36-110) months (P < .0001), respectively. The median operation times were 146 (range, 45-423) for TM and 193 (range, 65-386) minutes for SM (P = .2301). Perioperative complications were observed in one TM patient (9%) and two SM patients (9%) (P = 1.0000). The lengths of postoperative stay were similar. Recurrence was observed in two cases in the SM group (9%) within 1 year after the operation. CONCLUSION In LS, TM seems to be a feasible mesh comparable to SM within short- and mid-term follow-up.
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Affiliation(s)
- Katsuhito Suwa
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Takuro Ushigome
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Hiroya Enomoto
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Yuhei Tsukazaki
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Nana Takeuchi
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Tomoyoshi Okamoto
- Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University, Tokyo, Japan
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Dewulf M, Hildebrand ND, Bouwense SAW, Bouvy ND, Muysoms F. Parastomal hernias after cystectomy and ileal conduit urinary diversion: surgical treatment and the use of prophylactic mesh: a systematic review. BMC Surg 2022; 22:118. [PMID: 35351086 PMCID: PMC8966280 DOI: 10.1186/s12893-022-01509-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Parastomal hernia after ileal conduit urinary diversion is an underestimated and undertreated clinical entity, which heavily impairs patients' quality of life due to symptoms of pain, leakage, application or skin problems. As for all gastrointestinal stomata the best surgical repair technique has yet to be determined. Thereby, surgery for ileal conduit parastomal hernias poses some specific perioperative challenges. This review aims to give an overview of current evidence on the surgical treatment of parastomal hernia after cystectomy and ileal conduit urinary diversion, and on the use of prophylactic mesh at index surgery in its prevention. METHODS A systematic review was performed according to PRISMA-guidelines. The electronic databases Embase, PubMed, Cochrane Library, and Web of Science were searched. Studies were included if they presented postoperative outcomes of patients undergoing surgical treatment of parastomal hernia at the ileal conduit site, irrespective of the technique used. A search was performed to identify additional studies on prophylactic mesh in the prevention of ileal conduit parastomal hernia, that were not identified by the initial search. RESULTS Eight retrospective case-series were included for analysis, reporting different surgical techniques. If reported, highest complication rate was 45%. Recurrence rates varied highly, ranging from 0 to 80%. Notably, lower recurrence rates were reported in studies with shorter follow-up. Overall, available data suggest significant morbidity after the surgical treatment of ileal conduit parastomal hernias. Data from five conference abstracts on the matter were retrieved, and systematically reported. Regarding prophylactic mesh in the prevention of ileal conduit parastomal hernia, 5 communications were identified. All of them used keyhole mesh in a retromuscular position, and reported on favorable results in the mesh group without an increase in mesh-related complications. CONCLUSION Data on the surgical treatment of ileal conduit parastomal hernias and the use of prophylactic mesh in its prevention is scarce. Given the specific perioperative challenges and the paucity of reported results, more high-quality evidence is needed to determine the optimal treatment of this specific surgical problem. Initial results on the use of prophylactic mesh in the prevention of ileal conduit parastomal hernias seem promising.
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Affiliation(s)
- M Dewulf
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Department of Surgery, Maria Middelares, Gent, Belgium.
| | - N D Hildebrand
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - S A W Bouwense
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - F Muysoms
- Department of Surgery, Maria Middelares, Gent, Belgium
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How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias. Langenbecks Arch Surg 2022; 407:1291-1301. [PMID: 35088143 DOI: 10.1007/s00423-021-02393-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to complications and the optimal surgical treatment of this condition remains to be determined. METHODS In this article, we describe our surgical techniques in the minimally invasive treatment of ileal conduit parastomal hernia and present our preliminary results. In a retrospective single-center design, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected. RESULTS Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit. Details on the surgical approach are provided, along with a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings. The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66.7%). Median postoperative hospital stay was 5 days. One-third of patients developed a postoperative urinary infection. Median follow-up was 366 days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, treated with intraperitoneal mesh. CONCLUSION The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. Preliminary results confirm a significant morbidity after this type of surgery.
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Li B, Qin C, Luo H, Li G. Totally endoscopic sublay/extraperitoneal Sugarbaker mesh repair for parastomal hernia. Asian J Endosc Surg 2022; 15:244-248. [PMID: 34142764 DOI: 10.1111/ases.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Shared consensus is that a nonslit-mesh-based laparoscopic repair technique is the optimal treatment principle for parastomal hernia (PSH). MATERIALS AND SURGICAL TECHNIQUE An 81-year-old female parastomal hernia patient who had a previous history of laparoscopic abdominoperineal resection presented for surgical treatment. We performed a novel totally endoscopic sublay/extraperitoneal Sugarbaker mesh repair (TES-Sugarbaker) for this disease. The mesh was deployed in the sublay/extraperitoneal plane in a Sugarbaker configuration. DISCUSSION TES-Sugarbaker repair for parastomal hernia is technically feasible, it requires no anti-adhesive coated mesh and less traumatic fixation, then reduces the mesh-related complication and postoperative pain, making it more cost effective. The present described case represents an early attempt to perform endoscopic sublay/extraperitoneal mesh repair for PSH.
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Affiliation(s)
- Binggen Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Changfu Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, Beijing, China
| | - Hongyu Luo
- Department of General Surgery, The sixth people's hospital of Huizhou, Huizhou, Guangdong, China
| | - Guoxin Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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Synthetic Mesh in Contaminated Abdominal Wall Surgery: Friend or Foe? A Literature Review. J Gastrointest Surg 2022; 26:235-244. [PMID: 34590215 DOI: 10.1007/s11605-021-05155-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/17/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The use of synthetic mesh in contaminated fields is controversial. In the last decade, published data have grown in this matter suggesting favorable outcomes. However, multiple variables and scenarios that influence the results still make difficult to obtain convincing recommendations. METHODS We performed a review of relevant available data in English regarding the use of synthetic meshes in contaminated abdominal wall surgery using the Medline database. Articles including patients undergoing ventral hernia in contaminated fields were included for analysis. RESULTS Most studies support the use of synthetic meshes for ventral hernia repair in contaminated fields, as they have shown lower recurrence rate and similar wound morbidity. Although no mesh seems ideal in this setting, most surgeons advocate for the use of reduced-in-weight polypropylene mesh. Sublay location of the prosthesis associated with complete fascial closure appears to offer better results in these patients. In addition, current evidence suggests that the use of prophylactic synthetic mesh when performing a stoma or for stoma reversal incisional hernias might be beneficial. CONCLUSION A better understanding of surgical site occurrences and its prevention, as well as the introduction of new reduced-in-weight meshes have allowed using synthetic meshes in a contaminated field. Although the use of mesh has indeed shown promising results in these patients, the surgical team should still balance pros and cons at the time of placing synthetics in contaminated fields.
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Jiang H, Thapa DM, Cai X, Ma C, Wang M. Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique. Front Surg 2021; 8:740430. [PMID: 34676240 PMCID: PMC8524127 DOI: 10.3389/fsurg.2021.740430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia. Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique. Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm2. The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up. Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.
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Affiliation(s)
- Huiyong Jiang
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Dil Momin Thapa
- Clinical Medical School, Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Xiangjun Cai
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Chun Ma
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Mofei Wang
- Clinical Medical School, Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
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Xu AJ, Shakir NA, Jun MS, Zhao LC. Robotic Assisted Repair of Post-Ileal Conduit Parastomal Hernia: Technique and Outcomes. Urology 2021; 158:232-236. [PMID: 34481825 DOI: 10.1016/j.urology.2021.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/01/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a novel method of robotic assisted laparoscopic parastomal hernia repair (RAL-PHR), including the evolving use of the Da Vinci Single Port (SP) robotic system. METHODS Demographic, intraoperative, and postoperative variables were collected for patients who underwent RAL-PHR. The technique for RAL-PHR utilizes a 3 cm incision in the contralateral upper quadrant for the robotic trocar and a 12 mm assistant port. The hernia sac is freed from the fascial defect. Dual Surface Mesh is approximated to the fascial edges with a portion excised to tailor the conduit. RESULTS Four patients underwent RAL-PHR and three utilized the SP robot. Median age was 74.4 (range: 69.0-76.9) and median BMI 28.6 (26.5-43.2). All patients underwent cystectomy for bladder cancer and median time from index operation to parastomal hernia repair was 47.3 (40.4-11.48) months. Concurrent operations to hernia repair included ureteroenteric stricture repair, panniculectomy, abdominal wall reconstruction, stoma revision, and incisional hernia repair. Median operative time was 3.9 (2.6-8.7) hours including concurrent operations, median EBL was 50 (10-100) cc, mesh used in 3 cases, with no intraoperative complications reported. Median length of stay was 1 day and 1 post-operative complication greater than Clavien 2 reported. At median follow up of 18.3 (3.63-38.3) months, no recurrences were reported and 1 patient had undergone stoma dilation in the OR. CONCLUSION RAL-PHR using the SP system maximizes advantages of laparoscopic repair while allowing for flexibility to perform concurrent procedures and safer takedown of adhesions through just two incisions. RAL-PHR is a safe and effective alternative to open and laparoscopic parastomal hernia repair with several additional benefits.
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Affiliation(s)
- Alex J Xu
- NYU Langone Health, Department of Urology, New York, NY.
| | | | - Min S Jun
- NYU Langone Health, Department of Urology, New York, NY
| | - Lee C Zhao
- NYU Langone Health, Department of Urology, New York, NY
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Robin Valle de Lersundi A, Rupealta N, San Miguel Mendez C, Muñoz Rodriguez J, Pérez Flecha M, López Monclús J, Blazquez Hernando L, García Ureña MA. High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study. Colorectal Dis 2021; 23:2137-2145. [PMID: 34075675 DOI: 10.1111/codi.15729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 01/06/2023]
Abstract
AIM This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction. METHOD We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up. RESULTS Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m2 (range 25-47). Twelve patients had an expected associated risk according to the Carolinas equation for determining associated risk classification of >60%. Sixty per cent of our patients had contaminated or dirty/infected wounds. The overall complication rate was 60%. Surgical site infection was observed in 25% of the cases. The mortality rate in our study group was 5% (n = 1). We found clinical or radiological evidence of parastomal hernia recurrence in nine out of 20 (45%) patients during follow-up. No hernia recurrence was detected in the concomitant incisional hernias. CONCLUSIONS Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.
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Affiliation(s)
| | - Niccolo Rupealta
- Department of General Surgery, Hospital Universitario del Henares, Coslada, Spain
| | | | | | - Marina Pérez Flecha
- Department of General Surgery, Hospital Universitario del Henares, Coslada, Spain
| | - Javier López Monclús
- Department of General Surgery, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain
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Outcomes of redo-transversus abdominis release for abdominal wall reconstruction. Hernia 2021; 25:1581-1592. [PMID: 34287726 DOI: 10.1007/s10029-021-02457-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transversus abdominis release (TAR) is increasingly used to address complex ventral hernias; consequently, associated complications are seen more frequently. Our hernia center has a growing experience with redo-transversus abdominis release (redo-TAR) to address large, complex hernia recurrences after failed TAR. Here, we describe our outcomes after abdominal wall reconstruction with redo-TAR. STUDY DESIGN Adults undergoing elective open, redo-TAR at our institution from January 2015 to February 2021 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. The primary outcome was 30-day wound morbidity. Secondary outcomes were long-term composite hernia recurrence and patient-reported quality of life. RESULTS Sixty-five patients underwent redo-TAR. Median age was 60 years, 50.8% were female, and median BMI 31.8 kg/m2. Median recurrent hernias were 16 cm wide by 25 cm long. Frequent mechanisms of recurrence included linea semilunaris injury (27.7%), mesh fracture (18.5%), infection (16.9%), and posterior sheath disruption (15.4%). Wound complications occurred in 33.8% and 16.9% required procedural intervention. With median clinical and PRO follow-up of 12 and 19 months, respectively, the composite hernia recurrence rate was 22.5% and patients reported significantly improved quality of life (HerQLes: median + 36.7, PROMIS: median - 9.5). CONCLUSION Redo-TAR may be performed as a salvage procedure to reconstruct complex defects after failed TAR, however, in our center, it is associated with increased wound morbidity and fairly high composite recurrence rates. Despite this, patients report improvements in quality of life and pain. Tracking outcomes after TAR will facilitate understanding how to manage its failures.
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Liu D, Lang H, Romain B. Parastomal hernia repair using Pauli's technique (with video). J Visc Surg 2021; 158:358-359. [PMID: 34092527 DOI: 10.1016/j.jviscsurg.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D Liu
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - H Lang
- Service de Chirurgie Urologique, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67000 Strasbourg cedex, France
| | - B Romain
- Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Jiang H, Thapa DM, Ma C, Cai X, Wang M. Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report. Front Surg 2021; 8:659102. [PMID: 34095204 PMCID: PMC8173221 DOI: 10.3389/fsurg.2021.659102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique.
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Affiliation(s)
- Huiyong Jiang
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Dil Momin Thapa
- Clinical Medical School of Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Chun Ma
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Xiangjun Cai
- The Second Department of General Surgery, Northeast International Hospital, Shenyang, China
| | - Mofei Wang
- Clinical Medical School of Inner Mongolia University for the Nationalities, Tongliao, China.,The Second Department of General Surgery, The Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
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40
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San Miguel-Méndez C, López-Monclús J, Munoz-Rodriguez J, de Lersundi ÁRV, Artes-Caselles M, Blázquez Hernando LA, García-Hernandez JP, Minaya-Bravo AM, Garcia-Urena MÁ. Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias. Surgery 2021; 170:1112-1119. [PMID: 34020792 DOI: 10.1016/j.surg.2021.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. METHODS We presented a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 months (range, 6-62 months), 1 (2%) case of clinical recurrence was registered. Also, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative scores compared with the preoperative score. CONCLUSION Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients' reported outcomes.
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Affiliation(s)
- Carlos San Miguel-Méndez
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Javier López-Monclús
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain.
| | - Joaquín Munoz-Rodriguez
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Álvaro Robin Valle de Lersundi
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Mariano Artes-Caselles
- General and Digestive Surgery Department, Hospital Universitario Puerta de Hierro, Autónoma University of Madrid, Spain
| | - Luis Alberto Blázquez Hernando
- General and Digestive Surgery Department, Hospital Universitario Ramón y Cajal, Alcalá de Henares University Madrid, Spain
| | | | - Ana María Minaya-Bravo
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
| | - Miguel Ángel Garcia-Urena
- General and Digestive Surgery Department, Hospital Universitario del Henares, Francisco de Vitoria University, Madrid, Spain
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41
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Bloemendaal ALA. Minimally invasive parastomal hernia repair: laparoscopic vs. robot assisted-a video vignette. Colorectal Dis 2021; 23:1279-1280. [PMID: 33539621 DOI: 10.1111/codi.15564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 01/04/2023]
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Mäkäräinen-Uhlbäck E, Vironen J, Falenius V, Nordström P, Välikoski A, Kössi J, Kechagias A, Kalliala M, Mattila A, Rantanen T, Scheinin T, Ohtonen P, Rautio T. Parastomal Hernia: A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up. World J Surg 2021; 45:1742-1749. [PMID: 33560501 PMCID: PMC8093171 DOI: 10.1007/s00268-021-05990-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. METHODS All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007-2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. RESULTS In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007-2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0-146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. CONCLUSION The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.
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Affiliation(s)
- Elisa Mäkäräinen-Uhlbäck
- Department of Surgery, Medical Research Center, University of Oulu, Oulu University Hospital, 29, 90029 OYS, Oulu, PL, Finland.
| | - Jaana Vironen
- Abdominal Center, Helsinki University Hospital, PL 8000, 00029 HUS, Helsinki, Finland
| | - Ville Falenius
- Department of Surgery, University of Turku, PL 52, 20521, Turku, Finland
| | - Pia Nordström
- Department of Surgery, Tampere University Hospital, PL 2000, 3352o, Tampere, Finland
| | - Anu Välikoski
- Department of Surgery, Tampere University Hospital, PL 2000, 3352o, Tampere, Finland
| | - Jyrki Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Aristotelis Kechagias
- Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland
| | - Maija Kalliala
- Department of Surgery, Joensuu Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Anne Mattila
- Department of Surgery, Keski-Suomi Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland
| | - Tom Scheinin
- Abdominal Center, Helsinki University Hospital, PL 8000, 00029 HUS, Helsinki, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Oulu University Hospital, PL 29, 90029 OYS, Oulu, Finland.,The Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Medical Research Center, University of Oulu, Oulu University Hospital, 29, 90029 OYS, Oulu, PL, Finland
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43
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Lambrecht JR. Endoscopic preperitoneal parastomal hernia repair (ePauli repair) : an observational study. Surg Endosc 2021; 35:1903-1907. [PMID: 33398580 PMCID: PMC8292263 DOI: 10.1007/s00464-020-08192-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
Background Aspiring endoscopic surgery with extraperitoneal mesh application to avoid adhesion and pain from mesh fixation, we adopted the principles of the open Pauli repair of parastomal hernia (PSH). We have termed the procedure ePauli repair. The aim of this account is to inform about feasibility and adverse reactions. Methods Patients with PSH selected for ePauli repair with transversus abdominis release (TAR) were enrolled in a prospective observational study. Patients were operated with laparoscopic or robotic assistance and endoscopic Rives-Stoppa repair in cases with concomitant midline hernia. Coated meshes or a buffer mesh was used in the retromuscular pocket for this modification of the Sugarbaker principle. Results Fifteen patients were included: six patients were operated laparoscopically and nine patients with robotic assistance. The median age of the stomas was 33 months (7–313). Five PSHs were recurrent after previous repairs. Median operating time without midline hernia repair was 156 min (107–233) and with midline hernia repair 241 min (176–286). One serosa lesion arose during operation, prompting intraoperative revision of the ostomy without postoperative morbidity. Two patients had postoperative obstruction and were readmitted to operation: one with multiple adhesions and one had kinking of the stoma bowel caused by insufficient incision of the transversalis fascia. No infections or seromas have been observed. One patient had discoloring of the flank with spontaneous remission, and one patient had recurrence. Median postoperative admission time was 3 days (1–19). Median follow-up is 10 months (0–27). Conclusions ePauli repair is technically challenging but feasible. With our limited experience, we are encouraged with the pain, complication, and functional summary after ePauli repair and hopeful for the recurrence profile. ePauli/TAR is not for every patient or every surgeon and whether it should be restrained to recurrent PSH or be offered as first-line treatment for PSH is disputable. Electronic supplementary material The online version of this article (10.1007/s00464-020-08192-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Roland Lambrecht
- Department of Gastroenterological Surgery, Sykehuset Innlandet Hospital Trust, Furnesvegen 26, N-2380, Brumunddal, Norway.
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44
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Imamura K, Takada M, Umemoto K, Furukawa S, Ambo Y, Nakamura F. Laparoscopic parastomal herniorrhaphy utilizing transversus abdominis release and a modified Sugarbaker technique: A case report. Asian J Endosc Surg 2021; 14:106-108. [PMID: 32495518 DOI: 10.1111/ases.12804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Abstract
A 69-year-old woman was referred to our department with complaints of abdominal discomfort in the standing position. She had undergone robot-assisted radical cystectomy and ileal conduit urinary diversion for bladder cancer 10 months earlier. Abdominal CT revealed a parastomal hernia. Laparoscopic parastomal hernia repair using the Pauli technique was performed successfully with no recurrence after a 4-month follow-up. Although there are concerns about potential mesh-related complications and long-term results, this novel approach can be a successful option for parastomal hernia repair. As far as we know, this is the first English-language report on the application of Pauli parastomal hernia repair combined with a pure laparoscopic approach.
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Affiliation(s)
| | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | | | | | - Yoshiyasu Ambo
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
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45
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Ayuso SA, Shao JM, Deerenberg EB, Elhage SA, George MB, Heniford BT, Augenstein VA. Robotic Sugarbaker parastomal hernia repair: technique and outcomes. Hernia 2020; 25:809-815. [PMID: 33185770 DOI: 10.1007/s10029-020-02328-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To present a novel technique for the repair of parastomal hernias. METHODS A total of 15 patients underwent parastomal hernia repair. A robotic Sugarbaker technique was utilized for repair. The fascial defect was closed prior to robotic intraperitoneal placement of the mesh. Baseline demographics of the patients were obtained, and intra-operative and post-operative outcomes were tracked. RESULTS The etiology of the ostomies was oncologic in all but three patients. Five of the stomas were urostomies (33.3%). Patient characteristics were as follows: age 64.9.1 ± 9.3 years, BMI 30.1 ± 4.7 kg/m2, smoking history 60.0%, and diabetes 6.7%. The mean size of the hernia defect was 46.0 ± 40.1 cm2 with a mesh size of 372.0 ± 101.2 cm2. The mean operative time was 182.0 ± 51.9 min. In seven patients, an inferolateral preperitoneal flap was created for mesh placement. Intraoperatively, only one enterotomy was made during dissection, which was repaired without complication. The mean length of stay was 4.2 ± 1.9 days. There was only one hernia recurrence (6.7%). There were no wound complications, surgical site infections, or mesh infections. A mean follow-up time of 14.2 ± 9.4 months was achieved. CONCLUSIONS Robotic Sugarbaker parastomal hernia repair is a safe and effective technique. The results demonstrate the feasibility of fascial closure with this technique and a low recurrence rate. The authors propose this technique should be widely considered for parastomal hernia repair.
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Affiliation(s)
- S A Ayuso
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - J M Shao
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - E B Deerenberg
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - S A Elhage
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - M B George
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - B T Heniford
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - V A Augenstein
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA.
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46
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Giugliano DN, Bernier GV, Johnson EK. Other Surgeries in Patients with Inflammatory Bowel Disease. Surg Clin North Am 2019; 99:1163-1176. [PMID: 31676055 DOI: 10.1016/j.suc.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with inflammatory bowel disease (IBD) will often require abdominal surgical intervention for indications not directly related to their IBD. Because these patients often have a history of multiple previous abdominal operations and/or ostomies, they are at increased risk for incisional and parastomal hernias. They may also have develop symptomatic cholelithiasis, chronic pain, or desmoid disease. All of these potentially surgical issues may require special consideration in the IBD population.
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Affiliation(s)
- Danica N Giugliano
- Cooper University Hospital, Department of Surgery, 3 Cooper Plaza, Suite 411, Camden, NJ 08103, USA
| | - Greta V Bernier
- UW Medicine- Valley Medical Center, Colorectal Surgery Clinic, 4011 Talbot Road South, #420, Renton, WA 98055, USA
| | - Eric K Johnson
- Cleveland Clinic Colorectal Surgery, 6770 Mayfield Road #348, HC31, Mayfield Heights, OH 44124, USA.
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47
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Ramana B, Sinha R, Jacob B, Towfigh S, Rosin D. Acronyms Use in Abdominal Wall Reconstruction: Introduction to a New Language. World J Surg 2019; 44:78-83. [PMID: 31602519 DOI: 10.1007/s00268-019-05221-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of acronyms in medicine is widespread, aiming to simplify and condense communication. Online communication in social media platforms seems to enhance the use of acronyms, but their efficiency in message delivery may be negated by their abundance and unfamiliarity, causing more confusion than clarity. We analyzed the use of acronyms in a closed Facebook group dedicated to abdominal wall reconstruction (AWR), as the rapid recent development of this field has resulted in many new acronyms. Our aim was to classify the different acronyms and create a public reference. METHODS The International Hernia Collaboration, a hernia-related Facebook group, now communicating more than 7500 surgeons from 99 countries, was studied, by extracting acronyms used since its inception in 2012. Acronyms were categorized and interpreted, to create a small dictionary comprised of several tables. RESULTS Commonly used acronyms were identified, as well as commonly used prefixes that modify the acronyms' meaning. Tables were created, classifying acronyms by their subject: 1.Anatomy2.Diseases and clinical conditions3.Techniques and materials. CONCLUSION The use of acronyms increased in social media-based communication. Aiming to simplify the language, the inflation of terms may have achieved the opposite, by adding a multitude of unfamiliar and confusing terms. We have created a public reference for AWR-related acronyms. Limiting the liberal creation of new acronyms is recommended, especially in a rapidly changing field as AWR.
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Affiliation(s)
- B Ramana
- Apollo Gleneagles Hospital, Kolkata, India.
| | | | - Brian Jacob
- Icahn School of Medicine, Mount Sinai Laparoscopic Surgical Center of New York, New York, USA
| | | | - Danny Rosin
- Department of General Surgery and Transplantation, Sheba Medical Center Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kudsi OY, Gokcal F. Robotic approach to modified Sugarbaker parastomal hernia repair by performing transversus abdominis release - a video vignette. Colorectal Dis 2019; 21:854-855. [PMID: 30980574 DOI: 10.1111/codi.14645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 02/08/2023]
Affiliation(s)
- O Y Kudsi
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - F Gokcal
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts, USA
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Abstract
Ostomy creation is a routine surgical procedure that has earned its place high in the surgeon's armamentarium in dealing with challenging situations. However, it is not without its complications. In this article, we review the common complications including parastomal hernia, prolapse, mucocutaneous junction separation with ischemia and stenosis, peristomal skin conditions, and infections. Additionally, we review conditions that arise in association with underlying Crohn's disease, such as peristomal inflammation, fistula formation, and pyoderma gangrenosum.
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Affiliation(s)
- Armen Aboulian
- Department of General Surgery, Kaiser Permanente Medical Center, Woodland Hills, California
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50
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Huang DY, Pan L, Chen QL, Cai XY, Fang J. Modified laparoscopic Sugarbaker repair of parastomal hernia with a three-point anchoring technique. World J Clin Cases 2018; 6:759-766. [PMID: 30510940 PMCID: PMC6265003 DOI: 10.12998/wjcc.v6.i14.759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/13/2018] [Accepted: 10/12/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.
METHODS A retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbaker hernia repair treatment. This modified technique included an innovative three-point anchoring and complete suturing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to evaluate the safety and efficacy of this modified technique.
RESULTS Of these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modified laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruction of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 (visual analog scale method) at postoperative day 1. Two patients developed postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period (6-22 mo, average 13 mo).
CONCLUSION The modified laparoscopic Sugarbaker repair could fix the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.
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Affiliation(s)
- Di-Yu Huang
- Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Abdominal Viscera of Zhejiang Province, Hangzhou 310016, Zhejiang Province, China
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Long Pan
- Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Abdominal Viscera of Zhejiang Province, Hangzhou 310016, Zhejiang Province, China
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Qi-Long Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiao-Yan Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jie Fang
- Department of General Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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