From keyhole to sandwich: change in laparoscopic repair of parastomal hernias at a single centre

Bertoglio, Camillo Leonardo; Morini, Lorenzo; Maspero, Marianna; Zironda, Andrea; Alampi, Bruno; Mazzola, Michele; Magistro, Carmelo; Ferrari, Giovanni

doi:10.1007/s00464-020-07589-2

Cited by 12 publications

(5 citation statements)

References 39 publications

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“…The best results were associated with the use of Parietex compared to Physiomesh S. Rajapandian [ 26 ] 2019 Retrospective study 23 Abdominoperineal resection (14), perineal trauma (3), and uncontrolled perineal sepsis (1); total proctocolectomy (2), carcinoma bladder (3) Modified laparoscopic keyhole plus repair Colostomy (18); ileostomy (2); ileal conduit (3) 0 Composite mesh Intraperitoneal Seroma (3) 23 1 The laparoscopic modified keyhole plus repair technique is a safe, feasible, and effective PH repair when performed by experienced surgeons. It has an accept- able recurrence rate and offers good cosmesis and functional outcomes C. Bertoglio [ 37 ] 2020 Retrospective study 30 Miles (28), Harmann's (2), Cystoprostatectomy (2) Keyhole (19), Sandwich Repair (13) Colostomy (30), urostomy (2) 5 Gore-Tex Dual-Mesh (KH), DynaMesh-IPOM (SR) Intraperitoneal KH: parietal hematoma (1), Chronic seroma (2), bowel perforation (1). SB: chronic pain (1) 47 5 (KH); 0 (SR) Laparoscopic treatment of parastomal hernias with the “Sandwich Repair” technique seems to offer promising results, with a lower recurrence rate and less complications than the “Keyhole” technique V. A. Gameza [ 24 ] 2020 Nonrandomized case-controlled prospective study 90 Cancer (51), IBD (43), Miscellaneous (41) Keyhole technique (74), Sugarbaker technique (61) Colostomy (90), ileostomy (41), urostomy (4) 40 Two-layer mesh of PPM and ePTFE (72), Coated lightweight mesh of polypropylene (63) Intraperitoneal Intraoperative lesion of bowel (keyhole 9 vs sugarbaker 5) Stomal outlet obstruction (3 vs 3) Stoma-cutaneous fistula (0 vs 1) Peristomal infection (2 vs 0) Intra-abdominal bleeding (1 vs 0) Peritonitis (3 vs 3) 57...…”

Section: Resultsmentioning

confidence: 99%

“…Postoperative complications were found in the analysis as the main risk factor for hernia recurrence. Bertoglio et al [ 37 ] compared the outcomes after repair between 13 patients who underwent sandwich technique and 19 patients operated on with a KH repair. Patients’ demographics, characteristic of the defect, and postoperative outcomes were similar between the two groups, while in the sandwich repair group a statistically significant shorter length of hospital stay (p = 0.04) compared to KH repair was noted.…”

Section: Resultsmentioning

confidence: 99%

“…Such an approach is a blend of the KH and SB methods. The studies reported by Barranquero et al [ 36 ] and Bertoglio et al [ 37 ] showed a lower recurrence rate and shorter in-hospital stay when patients were operated on with such an approach, so suggesting a potential advantage over singular techniques.…”

Section: Discussionmentioning

confidence: 99%

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End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

Sarno,

Iacone,

Tedesco

et al. 2024

Hernia

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Introduction Parastomal hernia (PSH) is the most common and challenging complication after stoma creation, with an estimated 50% incidence 2 years after the index surgery. Mesh repair is the treatment of choice. Laparoscopic and/or robotic approaches allow acceptable outcomes. Materials and methods A systematic literature review from January 2012 to November 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Embase, PubMed, and Scopus search were performed to select articles dealing with minimally invasive surgical treatment for PSH after end colostomy. Results 603 studies were found, and 24 were chosen. When compared to open surgery, laparoscopy showed decreased postoperative complications and recurrence. The main laparoscopic approaches are the keyhole (KH), the Sugarbaker (SB), and the sandwich technique. Continuous improvement in surgery, mesh technology, and surgeons’ expertise led to an amelioration of surgical outcome and recurrence rate after repair. Recent studies showed comparable outcomes for SB and KH techniques, while novel surgical approaches have been proposed in an attempt to further increase the operative and long-term results. Reports on PSH robotic repairs are scarce and describe small series results, suggesting a role of the initial learning curve as a risk factor for complications. Conclusion End-colostomy PSH surgical repair still represents a challenge for surgeons. Recent evidence has not shown a significant advantage in postoperative complications and recurrence with a specific repair among SB, KH, and sandwich technique. The paucity of data on robotic surgery does not allow to draw definitive conclusion. Further primary, multicentric, and larger cohort studies are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

Sarno,

Iacone,

Tedesco

et al. 2024

Hernia

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“…Various techniques such as open, laparoscopic, and robotic surgery have been described for parastomal hernia repair (3). Commonly used laparoscopic repair techniques are the keyhole, Sugarbaker, and sandwich (4)(5)(6). An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia, which involves placing an anti-adhesion mesh with a special coating in contact with the bowel.…”

Section: Introductionmentioning

confidence: 99%

Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique

Jiang¹,

Thapa

Cai³

et al. 2021

Front. Surg.

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Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia.Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique.Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm2. The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up.Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.

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“…To date the laparoscopic (modified) Sugarbaker appears to be the best approach and is advised by the EHS guidelines [1]; however, that this approach appears to be the best is contradicted by a recent study [2]. A PSH recurrence rate of 8% has been reported for a new technique, using a ‘sandwich’ mesh repair, over a relatively short follow‐up period of time (median 26 months) in a small group ( n = 13) [3].…”

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confidence: 99%

Recurrent parastomal hernia after laparoscopic (modified) Sugarbaker: what to do? Robotic retromuscular mesh (Pauli) repair ‐ a video vignette

Bloemendaal

2021

Colorectal Disease

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From keyhole to sandwich: change in laparoscopic repair of parastomal hernias at a single centre

Cited by 12 publications

References 39 publications

End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique

Recurrent parastomal hernia after laparoscopic (modified) Sugarbaker: what to do? Robotic retromuscular mesh (Pauli) repair ‐ a video vignette

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