Victor Maciel, MD1,Gabriel Arevalo, MD2, Wilmer Mata, MD2, Tim Glass, MD, FACS2. 1Jackson South Community Hospital, 2St. Vincent Hospital
Introduction: The objective is to present our technique for robotic TAPP parastomal hernia repair.
Background: Parastomal hernias represent a significant problem with high recurrence and long-term complications. 120,000 new stomas are created per year with a prevalence of 800,000 patients in the U.S. Up to 40 to 60% of these new ostomies will never be reversed. 52% of patients with stomas will develop a hernia.
Parastomal hernias cause skin breakdown and make adherence of appliances difficult, creating the need for frequent bag exchanges. They can also cause pain, bowel obstruction and bowel incarceration or strangulation. All of these factors affect the patient’s quality of life and represent a significant burden to our health care system by causing multiple hospital admissions and increased use of outpatient resources.
There is no definitive gold-standard technique to repair parastomal hernias. As with other types of hernias, the use of prosthesis decreases the recurrence rates, yet using prosthetic material can result in long-term complications. Many surgeons are recognizing the importance of preventing prosthesis to be in contact with the intraabdominal viscera. This findings have led to develop techniques of pre-peritoneal mesh placement to provide long-lasting repairs and at the same time prevent complications associated with the mesh. We believe that a robotic pre-peritoneal approach provides a secure repair and avoids leaving prosthetic material in the abdominal cavity at the same time.
Methods: A three-arm technique is used, inserting ports opposite to the target anatomy. Adhesions are taken down to delineate the hernia defect, protecting the ostomy loop and mesentery. Once the hernia contents are reduced, the retrorectus space is entered at the contralateral side at the lateral border of the rectus abdominus muscle. This space is developed extensively across the midline and around the ostomy to allow for wide coverage of the mesh. Once the space is developed circumferentially around the ostomy, the hernia defect is approximated. Concomitant ventral hernias are also repaired. A polypropylene mesh with a keyhole is used and wide coverage is ensured in all directions, then it is positioned around the ostomy. The leaflets of the mesh are stitched together and the mesh is sutured to the abdominal wall. Finally, the peritoneum is closed.
Results: Only Short-term results are available. No perioperative complications or recurrence to date.
Conclusion: This is a novel minimally invasive technique to repair parastomal hernias that provides wide coverage of the defect and avoids leaving mesh intraperitoneally.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77909
Program Number: V120
Presentation Session: Hernia Video Session
Presentation Type: Video