Robotic Assisted Repair of Post-Ileal Conduit Parastomal Hernia: Technique and Outcomes

Laparoscopic Sugarbaker repair of parastomal hernia following radical cystectomy and ileal conduit: a single-center experience

PURPOSE

Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit.

METHODS

We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022.

RESULTS

Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25-38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery.

CONCLUSION

Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.

Robotic parastomal hernia repair in Ileal-conduit patients: short-term results in a single-center cohort study

PURPOSE

To describe and evaluate safety and feasibility of the robotic modified Sugarbaker technique with intraperitoneal underlay mesh (IPUM) for repairing parastomal hernias associated with ileal conduits (ICPSH).

METHODS

This retrospective, single-center cohort study analyzed data from 15 adult patients who underwent robotic ICPSH repair using the modified Sugarbaker IPUM technique between July 2021 and July 2023. The primary endpoints were hernia recurrence rates and 30-day morbidity. Secondary endpoints included length of stay, conversion to open surgery, 30-day readmission, and 30-day reoperation.

RESULTS

The mean patient age was 69.1 years, and 53.3% were female. Most patients (86.6%) had undergone radical cystectomy as the index surgery. The mean operative time was 249 min, with no conversions to open surgery. The 30-day complication rate was 26.7%, and the mean hospital stay was 3.6 days. No hernia recurrences, hydronephrosis, rise in creatinine or distended conduit on imaging suggesting poor drainage were observed during a mean follow-up of 15.2 months.

CONCLUSIONS

The robotic modified Sugarbaker IPUM technique appears safe and feasible for PSH repair in IC patients, with promising short-term outcomes. Further studies with larger cohorts and longer follow-up are needed to confirm its long-term efficacy and establish its role in ICPSH management.

Robotic parastomal hernia repair: A single-center cohort study

Parastomal hernia is a common occurrence following stoma construction, necessitating surgical intervention in symptomatic cases. This study presents a comprehensive analysis of Robotic-Assisted Parastomal Hernia Repair (r-PSHR), utilizing the Da Vinci Xi™ Surgical System. Retrospective analysis was conducted on patients undergoing r-PSHR at a high-volume center. Surgical variables, complications, and recurrence rates were assessed. The primary technique involved a modified Sugarbaker intraperitoneal onlay mesh. Eighty-six patients underwent r-PSHR, predominantly females (59.3%), with mean age 60.8 years. Mean BMI was 31.0. Most patients were classified as ASA 2 (31.4%) or ASA 3 (65.1), with 64.6% having no prior PSH repair. Index procedures primarily involved laparoscopic colonic resections (27.8%) and open abdominoperineal resections (27.8%). Parastomal hernias were mainly associated with end ileostomy (50%) and end colostomy (47.7%). A hybrid modification was required in 22.1% of cases, with only one conversion to open repair. Mean operative time was 257 min. Thirty-day morbidity was 40.7% and includes ileus (24.4%), deep surgical-site infections (7.0%), acute kidney injury (5.8%), and sepsis (5.8%). Grade IIIB complications occurred in 5.8% of cases. Thirty-day readmissions were observed in 19.8% of cases. There were five cases (5.8%) of recurrence within 15 months post-surgery. This study highlights the effectiveness of r-PSHR in managing parastomal hernia. R-PSHR shows promising outcomes with an acceptable post-operative occurrence profile and a favorable recurrence rate.