Cure laparoscopique de hernie parastomiale de Sugarbaker (2024)

T Huy Tess Huy, MD

A Bajinting Adam Bajinting, BS

J Greenspon Jose Greenspon, MD, FACS, FAAP

GA Villalona Gustavo A Villalona, MD

Epublication WebSurg.com, Mar 2020;20(03). URL: http://websurg.com/doi/vd01fr5926

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In this video, authors demonstrate a laparoscopic Sugarbaker technique for parastomal hernia repair using a Gore-Tex mesh in an 18-year-old man with a history of anal cancer status post-abdominoperineal resection with an end colostomy and known chronic parastomal hernia. His history also includes hypoplastic left heart syndrome status post-orthotopic cardiac transplant, DiGeorge syndrome, Hodgkin’s disease type post-transplant lymphoproliferative disease, and immune deficiency. He presented with abdominal pain, nausea, and vomiting secondary to small bowel obstruction at the site of his previous parastomal hernia. CT-scan showed a mesenteric swirl with a transition point. Upon laparoscopy, the parastomal hernia was identified. The bowel was reduced and hernia edges cauterized. Primary repair of the hernia defect was performed using a percutaneous technique. A Jackson-Pratt (JP) drain was left inside the hernia area and exited through a separate part of the abdomen. Following the Sugarbaker technique, a 16 by 20cm Gore-Tex dual mesh plus was used to reinforce the defect. Percutaneous sutures in the four corners secured the mesh. Once the mesh was in the desired location, absorbable tackers were used to attach the mesh to the anterior abdominal wall. Additional percutaneous sutures were added to the medial mesh. The patient recovered well. His nasogastric tube was removed on postoperative day (POD) 4. He was advanced to a regular diet and discharged on POD 7. Surveillance CT showed an intact repair with no recurrence a year after surgery. This case demonstrates a Sugarbaker technique for the closure of parastomal hernias using a Gore-Tex graft for parastomal hernias. The laparoscopic Sugarbaker technique is a safe procedure for the repair of parastomal hernias.

Tags

  • Générale et digestive
  • Paroi abdominale
  • Incisional hernia
  • Laparoscopic
  • Parastomal hernia
  • Sugarbaker

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Colonic stomal prolapse and parastomal incisional hernia: laparoscopic Sugarbaker repair procedure

The objective of this film is to demonstrate stoma prolapse and parastomal incisional hernia repair according to the technique described by Sugarbaker in open surgery, reproduced here with a laparoscopic approach.
Mesh placement into the abdominal cavity presents a risk that seems minimized by the development of dual-sided composite meshes, with one collagen coating that will be in contact with the digestive tract, hence limiting the risk of adhesions.
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Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair

Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.

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Transumbilical single-access laparoscopic subxiphoidal incisional hernia repair

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Video: The umbilical scar was incised and, after having placed a fascial umbilical purse-string suture, an 11mm reusable trocar was introduced. DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were introduced. The subxiphoidal hernia was put in evidence. The fatty tissue covering the defect was freed and the hernia defect was measured to be 8cm cranio-caudally and 6cm latero-laterally. A dual face mesh of 15 and 14cm (Surgimesh XB, Aspide Medical, Saint-Etienne, France) was chosen and introduced into the cavity through the 11mm trocar. The mesh was fixed against the abdominal wall using absorbable tacks (Sorbafix, Bard Davol Inc., Warwick, RI, US), and against the pericardial sheet using a polypropylene suture, in order to prevent any potential cardiac tamponade.

Results: The final umbilical scar was 15mm. Operative time was 65 minutes, and operative bleeding was insignificant. The patient was discharged on postoperative day 1. At visit consultations, no recurrence was evidenced.

Conclusion: Subxiphoidal incisional hernia after open cardiac surgery can be treated successfully using a transumbilical single access laparoscopy.

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Cure laparoscopique de hernie parastomiale de Sugarbaker (2024)
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