Robotic retro-rectus repair of parastomal hernias

Maciel, Victor; Mata, Wilmer; Arevalo, Gabriel; Zeichen, Marianna; Glass, Timothy

doi:10.1007/s11701-018-0874-6

Cited by 11 publications

(9 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This patient population is noted to be at high risk for postoperative complications and prolonged hospital stay with a CCI score of 4.6. This identifies their 10-year survival at 21% to 53% [5,10]. Although the use of robotic surgery for flap harvest in reconstructive surgery has been cited in several studies [10−12], reconstructive outcome data remain underreported, particularly in medically complex patients.…”

Section: Discussionmentioning

confidence: 99%

A Case Series of Robot-assisted Rectus Abdominis Flap Harvest for Pelvic Reconstruction: A Single Institution Experience

Haverland¹,

Rebecca²,

Hammond

et al. 2021

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

To analyze outcomes and postoperative complications in patients undergoing robot-assisted rectus abdominis flap harvest for pelvic floor reconstruction. Design: Case series. Setting: Academic setting. Patients: Pelvic reconstruction surgery patients. Interventions: The rectus abdominis muscle flap can be used as a flap for pelvic reconstruction, providing a large volume of soft tissue that can be used in the treatment of many comorbid conditions, including genital fistulas, postradiation pelvic exenteration, and abdominoperineal resection defects. Intraperitoneal harvest of the rectus muscle using a robotic approach allows avoidance of laparotomy and subsequent disruption of the anterior rectus sheath, thus preserving the integrity of the abdominal wall. Measurements and Main Results: A retrospective analysis of patient demographic and clinical characteristics was performed for all patients who underwent robot-assisted rectus abdominis flap harvest for pelvic floor reconstruction at our institution from October 1, 2016, to October 31, 2018. The postoperative complications analyzed included bowel obstructions, surgical site infections, emergency room visits, and need for readmission. Six patients (4 women and 2 men), with a mean age of 69.2 years (range = 57−79 years) and median follow-up time of 9.2 months (range = 5−12 months), were included. Muscle flap harvest was performed on the right side in 4 patients and on the left in 2 patients. The indications for reconstructive surgery included vesicovaginal fistula, complex pelvic organ prolapse, anterior and posterior exenteration, partial and total vaginectomy, partial vulvectomy, and abdominoperineal resection. Two patients received neoadjuvant chemoradiation. One of the 6 cases was converted to laparotomy; however, this was not owing to the rectus harvest. Three patients experienced no complications after reconstruction; 1 patient reported occasional abdominal pain; 1 patient had intermittent bowel obstruction; and 1 patient developed a pelvic abscess, requiring readmission. All 6 patients achieved satisfactory healing of the pelvic wound after robot-assisted rectus abdominis flap inset. Conclusion: Robot-assisted rectus abdominis flap harvest for pelvic floor reconstruction is a reliable means of defect closure, despite the presence of substantial comorbidities and risk factors in this patient cohort. Patient selection and counseling are crucial to optimize surgical outcomes in this complex population.

show abstract

Section: Discussionmentioning

confidence: 99%

A Case Series of Robot-assisted Rectus Abdominis Flap Harvest for Pelvic Reconstruction: A Single Institution Experience

Haverland¹,

Rebecca²,

Hammond

et al. 2021

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

show abstract

“…If a suture non-mesh repair is no more recommended except in emergency setting because of the excessive risk of recurrence, mesh augmentation accounting for 90% of PSH repairs is the technique of choice, allowing to significantly reduce the risk of recurrence [5,13]. Minimally invasive repairs, through laparoscopy and more recently by robotic approach [14][15][16][17], seem to be the treatment of choice. The objective of this manuscript is to systematically review the current up-to-date evidence concerning minimally invasive techniques focusing on end-colostomy PSH repair in the setting of a laparoscopic or robotic approach.…”

Section: Introductionmentioning

confidence: 99%

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

Sarno,

Iacone,

Tedesco

et al. 2024

Hernia

View full text Add to dashboard Cite

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.

show abstract

“…In search of further improvement of treatment of PSH, Pauli et al described a PSH repair with retromuscular placement of the non-keyhole mesh and a limited unilateral posterior component separation/transversus abdominis release (PCS/TAR) with a recurrence rate of 4.5% at 10 months [ 10 ]. The technique was subsequently modified to a robotic repair to combine the benefits of minimally invasive surgery and retromuscular mesh placement [ 11 ]. In this technique, however, there will still be intimate contact between the stoma conduit and the synthetic mesh, which may again lead to devastating mesh-related complications, necessitating major revisional and salvage surgery [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Robotic Retromuscular (Recurrent) Parastomal Hernia Repair (r-Pauli-Repair) With Synthetically Reinforced Biological Mesh; Technique, Early Experience, and Short-Term Follow-Up

Bloemendaal

2023

J. Abdom. Wall Surg.

View full text Add to dashboard Cite

Introduction: Parastomal hernia repair remains a challenge. We describe a robotic retromuscular non-keyhole mesh repair using a synthetically reinforced biological mesh (Ovitex) for the repair of complex and/or recurrent parastomal hernia and technical modifications we made along the way to improve our technique.Methods: All patients underwent the described retromuscular parastomal hernia repair. Data was collected in a database and a retrospective analysis was performed on direct postoperative results and early follow-up.Results: Eleven patients underwent the operation. Median follow-up was 12 months. Median LOS was 6 days. Two recurrences occurred. One patient suffered postoperative hematoma and skin necrosis, which healed completely, but did lead to a recurrence. One patient had a significant seroma, which subsided without intervention. Both recurrences were reoperated, and a local repair was performed.Conclusion: This paper is the first to describe a modified robotic Pauli repair for complex and recurrent parastomal hernia, using a synthetically reinforced biological mesh. Results are satisfying so far, especially considering the complexity of the cases.

show abstract

Robotic retro-rectus repair of parastomal hernias

Cited by 11 publications

References 34 publications

A Case Series of Robot-assisted Rectus Abdominis Flap Harvest for Pelvic Reconstruction: A Single Institution Experience

A Case Series of Robot-assisted Rectus Abdominis Flap Harvest for Pelvic Reconstruction: A Single Institution Experience

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

Robotic Retromuscular (Recurrent) Parastomal Hernia Repair (r-Pauli-Repair) With Synthetically Reinforced Biological Mesh; Technique, Early Experience, and Short-Term Follow-Up

Contact Info

Product

Resources

About