Parastomal Hernia Repair: Laparoscopic Modified Sugarbaker Technique Results in Superior Recurrence Rate

Asma Asif, BS, Melissa Ruiz, MD, Amy Yetasook, BS, Joann Carbray, BA, Woody Denham, MD, John Linn, MD, Michael B Ujiki, MD. NorthShore University Health System

Background: Parastomal hernia (PH) is a frequent complication of stoma formation, occurring in 35%-50% of patients. Recurrence after repair is common, ranging from 24% to 54% of cases. We hypothesized that repair using a laparoscopic modified Sugarbaker technique (SB) would result in a superior recurrence rate when compared to other repairs.

Methods: An IRB approved retrospective review of all patients who underwent PH repair between 2004-2011 was performed. We collected demographics, factors related to ostomy formation, risk factors for hernia, intra-operative, and post-operative information as well as the absence or presence of PH on their last physical exam or imaging study.

Results: Forty-nine PH repairs were performed: 33 (67%) paraileostomy and 16 (33%) paracolostomy. Repairs included 14 laparoscopic modified SB, 18 laparoscopic keyhole, 11 ostomy re-sitings, 3 open repairs without mesh, and 3 open repairs with mesh. There was no statistically significant difference between groups when comparing mean age, BMI, smoking status, steroid use, ostomy type, location, primary diagnoses, or complication rate. Recurrence rates were SB 0%, keyhole 61.1%, re-siting 63.6%, and open repair +/- mesh 16.6%. When SB was compared to all groups, the incidence of recurrence was significantly lower (p< 0.001) but follow-up was as well (7.2 vs 32.7 months). When the analysis was restricted to the 28 repairs performed between 2009-2011, there was no significant difference between the groups in terms of the above-mentioned characteristics or the follow-up period (7.2 months for SB group versus 11.8 months for all others), but again there was a significant difference in PH recurrence (0 of 14 for the SB group versus 8 of 14, p<0.01). In addition, there were no differences in post-op complication rates among all of the techniques.

Conclusion: The modified SB technique may offer patients a significant decrease in the risk of recurrence compared to other PH repair techniques with no significant increase in post-op complications.