EARLY OUTCOMES OF ROBOTIC PAULI FOR PARASTOMAL HERNIA REPAIR

Abstract

Abstract Background The Pauli technique for parastomal hernia repair involves the dissection of the retromuscular space, transversus abdominis release and lateralization of the stoma with the placement of a retromuscular mesh. Limited evidence exists regarding the robotic approach to this technique. The objective was to assess the outcomes at our centre. Method Observational retrospective study. Patients included underwent an elective robotic Pauli technique for the repair of a parastomal hernia associated with an end colostomy. All patients underwent surgery in a tertiary referral centre from September 2020 to December 2022. Results A total of 21 patients underwent a robotic Pauli in our study. The parastomal hernias intervened according to the European Hernia Society classification were 9.5% (2/21) type I, 52.4% (11/21) type II, 23.8% (5/21) type III, 14.3% (3/21) type IV. Early complications observed included 14.3% (3/21) seroma, 9.5% (2/21) surgical site infection, 19% (4/21) postoperative ileus, and one case of large bowel obstruction due to colitis (4.8%), which was managed conservatively. No Clavien-Dindo grade III complications were reported. The overall recurrence rate was 9.5% (2/21) with a median follow-up of 12.5 months (IQR: 3.9–21.3). Only 28.6% (6/21) of the sample achieved a 2-year follow-up. Both recurrences occurred during the early phases of the learning curve and were likely attributed to insufficient lateralization of the stoma. Conclusions Robotic Pauli for parastomal hernia repair is a challenging procedure with promising results in terms of recurrence.