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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 (Heidelb) 2022; 93:129-140. [PMID: 36480037 DOI: 10.1007/s00104-022-01779-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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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 (Heidelb) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lambrecht JR. Diagnostic methods in parastomal hernia; research and clinical relevance. Hernia 2020; 25:817-820. [PMID: 32222841 DOI: 10.1007/s10029-020-02177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J R Lambrecht
- Department of Gastroenterological Surgery, Sykehuset Innlandet Hospital Trust, Kyrre Grepsgate 11, 2819, Gjøvik, Norway.
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Wasmuth HH, Færden AE, Myklebust TÅ, Pfeffer F, Norderval S, Riis R, Olsen OC, Lambrecht JR, Kørner H, Larsen SG, Forsmo HM, Bækkelund O, Lavik S, Knapp JC, Sjo O, Rashid G. Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 2019; 107:121-130. [DOI: 10.1002/bjs.11459] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Background
Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates.
Methods
Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast). Kaplan–Meier estimates were used to compare local recurrence.
Results
In Norway, 157 patients underwent TaTME for rectal cancer between October 2014 and October 2018. Three of seven hospitals abandoned TaTME after a total of five procedures. The local recurrence rate was 12 of 157 (7·6 per cent); eight local recurrences were multifocal or extensive. The estimated local recurrence rate at 2·4 years was 11·6 (95 per cent c.i. 6·6 to 19·9) per cent after TaTME compared with 2·4 (1·4 to 4·3) per cent in the NCCR (P < 0·001). The adjusted hazard ratio was 6·71 (95 per cent c.i. 2·94 to 15·32). Anastomotic leaks resulting in reoperation occurred in 8·4 per cent of patients in the TaTME cohort compared with 4·5 per cent in NoRGast (P = 0·047). Fifty-six patients (35·7 per cent) had a stoma at latest follow-up; 39 (24·8 per cent) were permanent.
Conclusion
Anastomotic leak rates after TaTME were higher than national rates; local recurrence rates and growth patterns were unfavourable.
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Affiliation(s)
- H H Wasmuth
- Department of Gastrointestinal Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A E Færden
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - T Å Myklebust
- Department of Registration, Cancer Registry Norway, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - F Pfeffer
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - S Norderval
- Department of Gastrointestinal Surgery, Tromsø University Hospital, University of Northern Norway, Tromsø, Norway
| | - R Riis
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
| | - O C Olsen
- Department of Gastrointestinal Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - J R Lambrecht
- Department of Surgery, Gjøvik Hospital, Innlandet Hospital Trust, Gjøvik, Norway
| | - H Kørner
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - S G Larsen
- Department of Gastrointestinal Surgery, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Jänes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, López-Cano M, Maggiori L, Mandalà V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Śmietański M, Szczepkowski M, Stabilini C, Muysoms FE. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2017; 22:183-198. [PMID: 29134456 DOI: 10.1007/s10029-017-1697-5] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 08/19/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. METHODS The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. RESULTS End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. CONCLUSION An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.
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Affiliation(s)
- S A Antoniou
- Department of General Surgery, University Hospital of Herakion, Crete, Greece.
| | - F Agresta
- Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - J M Garcia Alamino
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - D Berger
- Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden, Germany
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H-T Brandsma
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - K Bury
- Department Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - J Conze
- Herniacenter Dr. Muschaweck/Dr. Conze, Munich, Germany
- Herniacenter Dr. Muschaweck/Dr. Conze, London, UK
- Department of General, Visceral and Transplant Surgery, University Hospital, RWTH Aachen University, Aachen, Germany
| | - D Cuccurullo
- Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera dei Colli, Naples, Italy
| | - U A Dietz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - R H Fortelny
- Certified Hernia Center, Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - C Frei-Lanter
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - B Hansson
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F Helgstrand
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - A Hotouras
- National Bowel Research Centre, The Royal London Hospital, London, United Kingdom
| | - A Jänes
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - L F Kroese
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J R Lambrecht
- Surgical Department, Innlandet Hospital Trust, Gjøvik, Norway
| | - I Kyle-Leinhase
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - M López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - V Mandalà
- Department of General Surgery, Buccheri La Ferla Hospital, Palermo, Italy
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - M Prudhomme
- Digestive Surgery Department, CHU Nîmes, Nîmes, France
| | - T Rautio
- Department of Surgery, Division of Gastroenterology, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - N Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - M Śmietański
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of General Surgery and Hernia Centre, District Hospital in Puck, Puck, Poland
| | - M Szczepkowski
- Department of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
- Clinical Department of General and Colorectal Surgery, Bielanski Hospital, Warsaw, Poland
| | - C Stabilini
- Department of Surgery, University of Genoa, Genoa, Italy
| | - F E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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Lambrecht JR, Larsen SG, Reiertsen O, Vaktskjold A, Julsrud L, Flatmark K. Prophylactic mesh at end-colostomy construction reduces parastomal hernia rate: a randomized trial. Colorectal Dis 2015; 17:O191-7. [PMID: 26179984 DOI: 10.1111/codi.13065] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/21/2015] [Indexed: 12/13/2022]
Abstract
AIM Parastomal hernia (PSH) is the most common complication of an end-colostomy and about one-quarter of patients need operative repair, which is often unsuccessful. A randomized trial was carried out to compare the results of using mesh or no mesh at the time of formation of a colostomy with the clinical identification of PSH as the primary outcome. METHOD In this two-centre randomized trial (Oslo University Hospital and Sykehuset Innlandet Hospital Trust, Norway), patients with rectal cancer undergoing open pelvic surgery were randomized to receive a retromuscular synthetic mesh (study group, n = 32) or no mesh (control group, n = 26) at the time of end-colostomy formation. Postoperative follow up was not blinded and included clinical examination and routine CT. RESULTS The median period of follow up was 40 (range: 84) months. There were no differences in demographic variables or complications between the study and control groups. PSH developed in two patients of the study group and in 12 of the control group [OR = 0.04 (95% CI: 0.01-0.30) and hazard ratio 0.134 (95% CI: 0.030-0.603); P < 0.001]. The number needed to treat to avoid one PSH was 2.5 patients. CT demonstrated an increase over time in the size of the fascial orifice in patients with PSH without mesh prophylaxis, in contrast to a stable size in patients with mesh and in the control patients who did not develop PSH. CONCLUSION The retromuscular insertion of synthetic mesh at the time of formation of an end-colostomy reduced the risk of PSH.
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Affiliation(s)
- J R Lambrecht
- Department of Gastroenterological Surgery, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S G Larsen
- Department of Gastroenterological Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - O Reiertsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Digestive Surgery, Akershus University Hospital, Oslo, Norway
| | - A Vaktskjold
- Department of Gastroenterological Surgery, Sykehuset Innlandet Hospital Trust, Gjøvik, Norway.,Hedmark University College, Elverum, Norway
| | - L Julsrud
- Department of Radiology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - K Flatmark
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterological Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
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Lambrecht JR, Skauby M, Trondsen E, Vaktskjold A, Øyen OM. Laparoscopic repair of incisional hernia in solid organ-transplanted patients: the method of choice? Transpl Int 2014; 27:712-20. [PMID: 24684675 DOI: 10.1111/tri.12327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/03/2014] [Accepted: 03/26/2014] [Indexed: 12/31/2022]
Abstract
Due to immunosuppressive (IS) therapy, incisional hernias are overrepresented in the organ-transplanted (Tx) population with larger defects, a high rate of recurrence, and a tendency toward more seromas and infectious problems. Thirty-one Tx/IS patients with a control group of 70 non-IS patients with incisional hernia (6/7 recurrences) were included in a prospective interventional study. Both cohorts were treated with laparoscopic ventral hernia repair (LVHR). Follow-up time and rate was 37 months and 95%. One hundred LVHR's were completed as there was one conversion in the Tx/IS group. No late infections or mesh removals occurred. Recurrence rates were 9.7% vs. 4.2% (P = 0.37) and the overall complication rates were 19% vs. 27% (P = 0.80). The Tx/IS group had a higher mesh-protrusion rate (29% vs. 13%, P = 0.09), but also larger hernias. Polycystic kidney disease was overrepresented in the Tx cohort (44% of kidney-Tx). Incisional hernias in Tx/IS patients may be treated by LVHR with the same low complication rate and recurrence rate as non-IS patients. By LVHR, the highly problematic seroma/infection problems encountered in Tx/IS patients treated by conventional open technique seem almost eliminated. The minimally invasive procedure seems particularly rational in the Tx/Is population and should be the method of choice. (ClinicalTrials.gov number: NCT00455299, date: 5 May 2006).
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Affiliation(s)
- Jan R Lambrecht
- Surgical Department, Sykehuset Innlandet Health Trust, Brumunddal, Norway
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