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Laparoscopic Parastomal Hernia Repair with Primary Fascial Closure and Keyhole Mesh Repair

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

46

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