Gabriela M Aguiluz, MD, Michael Cudworth, MD, Roberto Bustos, MD, Mario Masrur, MD. University of Illinois Hospital & Health Sciences System
A 45-year-old female patient with obesity and history of Crohn’s disease and fecal incontinence that underwent a robot-assisted abdominoperineal resection with end colostomy. Three months postoperatively, the patient complained of pain and bulging around the stoma. A CT scan of the abdomen and pelvis showed a large parastomal hernia with small bowel loops in the hernia sac. Decision was made to perform a robot-assisted parastomal hernia repair.
Sugarbaker technique was used to repair the hernia due to reported lower recurrence rates as compared to the laparoscopic Keyhole technique. Procedure commenced with lysis of adhesions, reduction of the hernia sac contents, the hernia defect was then closed primarily utilizing a barbed suture, followed with placement of a large knitted biological mesh, secured in place with interrupted vicryl sutures. After which, the edges were secured with an additional running barbed suture, with the ostomy limb displaced laterally without tension. The procedure was carried out with no complications. The operative time was 191 min and estimated blood loss of 30cc.
On postoperative day 3, the patient developed ileus which resolved with conservative management. The patient was discharged on postoperative day 8. At 3 month follow up, the patient was doing well with no evidence of recurrence.
Utilization of the robotic platform provides increased surgical dexterity, highly precise suturing and more optimal surgical visualization as compared to traditional laparoscopy, which facilitates repair of large parastomal hernias in a minimally invasive fashion, including easier primary hernia repair and mesh fixation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94599
Program Number: V402
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop