Evan Liggett, MD, Ellen Wicker, DO, Carlos Lodeiro, BS, Benjamin Clapp, MD. Texas Tech HSC Paul Foster School of Medicine
Introduction: Bladder and urethral malignancies can require resection with a curative intent. The patient that undergoes resection will need a urinary conduit. The ileum can be used as a conduit for patients that have their bladder resected for cancer. For urethral cancers, the bladder can be preserved and the appendix can be used as the urinary conduit. This is called the Mitrofanoff Procedure.
Description of Video: This video highlights the repair of a parastomal hernia from an appendiceal-vesicular urinary conduit. The patient is a 58-year-old male with a history of urethral cancer who underwent the Mitrofanoff Procedure. He had developed a parastomal hernia one year after surgery which was repaired with a biologic mesh in an open keyhole technique. Two years after that he presented with a recurrent parastomal hernia and a bowel obstruction. The video shows a complete lysis of adhesions with preservation of the urinary conduit with placement of a bioabsorbable mesh.
Discussion: Parastomal hernias are common, occurring in up to 60% of cases. General surgeons need to be able to address all parastomal hernias. Ideally a mesh can be used to repair the hernia using the Keyhole technique or the Sugarbaker technique. In worse case scenarios the stoma itself can be repositioned in the abdominal wall. The types of mesh used can be prosthetic, biologic or bioabsorbable. Bioabsorbable meshes seem to have less perioperative complications, but their long-term outcomes are unknown.
Conclusions: Parastomal hernias can be repaired safely laparoscopically. Bioabsorbable meshes seem ideally suited for these repairs, but their long-term outcomes are unknown.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91766
Program Number: V319
Presentation Session: Panel: How Would You Approach This? Complex and Challenging Hernia Case Presentations
Presentation Type: Panel