Robotic‐assisted parastomal hernia repair using the Sugarbaker technique

Abstract

Parastomal hernias (PHs) are a common condition with an incidence of over 50%, 3 years after ostomy construction [1]. Surgical repair of PHs has historically been challenged by the high recurrence rate following primary suture repair [2]. The use of prophylactic mesh during the construction of end colostomies has been suggested and is highly recommended for definitive PH repair in addition to primary ostomy closure if that is an option [1, 3, 4]. Multiple hernia repair techniques have been described, including both open and minimally invasive approaches. The options include mesh-based repairs in different anatomical locations, such as the intraperitoneal space (Keyhole and Sugarbaker techniques) and the retrorectus plane, with or without transversus abdominis release [5, 6]. In this video vignette, we describe a modified Sugarbaker repair with permanent mesh in a patient who underwent an abdominoperineal resection (APR) for low rectal cancer. Robotic Sugarbaker PH repair has proven to be a safe and effective option with recurrence rates comparable with those of other techniques [7-9]. Video 1 shows the feasibility, anatomical landmarks and steps of a robotic Sugarbaker PH repair in a patient with an end colostomy after an APR. The procedure included complete lysis of adhesions with reduction of the hernia contents into the abdominal cavity, followed by primary closure of the hernia defect, lateralization of the colon and mesh placement with circumferential and central securement. Francisco J. Cardenas Lara: Writing – review and editing; visualization; project administration; resources; conceptualization; investigation; writing – original draft. Robert R. Cima: Conceptualization; validation; visualization; writing – review and editing; project administration; supervision; resources. The authors agree to be accountable for all aspects of the work and ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. None reported for all authors. This work was approved by the Institutional Review Board for research. Informed consent was obtained from the patient to being photographed or videotaped for education of professional staff and medical or scientifical purposes. Data sharing is not applicable to this article as no new data were created or analysed in this study.