V12-11: Laparoscopic repair of ileal conduit parastomal hernia using the modified Sugarbaker technique
Parastomal hernia is a common complication of stoma formation, The reported incidence is variable depending on the degree, the duration of follow-up and the type of stoma. The incidence for ileal conduits ranges from 2% to 6.5%. Modified laparoscopy Sugarbaker technique is a possible method to repair ileal conduit parastomal hernia.
We present a case of the laparoscopic modified Sugarbaker technique applied to repair a ileal conduit parastomal hernia in a 67 years-old patient with a history of radical cystoprostatectomy and Bricker uretero-ileostomy for a bladder cancer seven years ago. The procedure is described in detail in this video.
The patient was positioned supine with both arms tucked. The abdomen was accessed using a 10-mm trocar in the axillary line, in front of the ileostomy , a 10-mm trocar by subxiphoid approach and a 5-mm trocar in the left lower quadrant._x000D_ A tedious lysis of adhesions was performed with minimal use of bipolar energy. Liberation of omental adhesions in the foramen of parastomal hernia and extraction of 40 cm. of small bowel located in parastomal hernia were performed.The parastomal hernia defect were identified and measured. We used a 15 cm x 20 cm physiomesh® mesh. The fine filament design and its macroporous structure flexible, facilitate the scar tissue formation and adaptation to the abdominal wall. The mesh was tacked in position to the abdominal wall in its periphery using the 5-mm tacking device. When we place the takers should make an external pressure on the abdominal wall. Several takers are placed in the abdominal wall, circumferentially around the ileal loop. The patient was discharged after a 2-day stay. After 20 months of follow up, the patient is free of recurrence of parstomal hernia.
The introduction of prosthetic meshes significantly decreases the recurrence rates of parastomal hernia. Laparoscopic surgery reduces_x000D_ postoperative pain, recovery time and minimize many of the morbidities associated with open procedures. Laparoscopic parastomal hernia repair has a viable option to overcome the challenges that face the hernia surgeon.