Luanne Force, MD, Yuksel Altinel, MD, Samuel Szomstein, MD, Steven D Wexner, MD. Cleveland Clinic Florida, Weston, FL
Objectives: To describe the technique for laparoscopic parastomal hernia repair with primary fascial closure and keyhole mesh underlay.
Case: A 51-year-old male with a BMI of 30 kg/(m2) with a history of T3N0M1 distal rectal tumor was treated with neoadjuvant chemoradiation, abdominoperineal resection followed by adjuvant chemotherapy. He developed a symptomatic parastomal hernia 6 months post operatively.
Technique: Abdominal access was obtained by placing a 12mm cannula by Hasson technique in the left upper quadrant. A total of 4 ports were placed on the right side. Laparoscopic adhesiolysis was performed sharply. The parastomal and umbilical hernia defects were then clearly visualized. Fascial closure was then performed laparoscopically with a barbed Quill (surgical specialties corporation) suture. The parastomal hernia defect was closed in a running fashion. The pneumoperitoneum was released after each pass to ensure full closure, then secured with a clip. A finger was placed within the stoma to ensure the closure was not too tight. The umbilical defect was closed with a figure of eight stitch. Composite mesh was delivered into the abdominal cavity via the 12mm port. It was then affixed to the abdominal wall with a 5mm tacking device. Digital examination of the stoma was repeated to ensure that the repair was not too tight.
Results: The patient was discharged in stable condition without any postoperative complications at 8-weeks follow up.
Conclusion: Laparascopic parastomal hernia repair is feasible, with good outcomes. The use of a barbed suture facilitates fascial closure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88277
Program Number: V183
Presentation Session: Wednesday Video Loop (Non CME)
Presentation Type: VideoLoop