Laparoscopic Repair of Ileal Conduit Parastomal Hernia Using the Modified Sugarbaker Technique

Laparoscopic Repair of Ileal Conduit Parastomal Hernia Using the Modified Sugarbaker Technique

Dario Garcia-Rojo MD1,2; Xavier Serra, MD2; Raul Martos, MD2; Leticia De Verdonces, MD2; Jesus Muñoz, MD2; Marta Capdevila, MD2; Angel Prera, MD2; Juan Prats2

1.Hospital Sabadell
2. Universitat Autonoma Barcelona


Objectives: Parastomal hernia is a common complication of stoma formation. The incidence for ileal conduits ranges from 2% to 40%. Modified laparoscopy Sugarbaker technique is a possible method to repair ileal conduit parastomal hernia.

Methods & Procedures: We present a case of the laparoscopic modified Sugarbaker technique applied to repair a ileal conduit parastomal hernia in a 67 years-old patient with a history of radical cystoprostatectomy and Bricker uretero-ileostomy for a bladder cancer seven years ago.

RESULTS: The patient was positioned supine. The abdomen was accessed using a 10-mm trocar in the axillary line, in front of the ileostomy, a 10-mm trocar by subxiphoid approach and a 5-mm trocar in the left lower quadrant. Liberation of omental adhesions in the foramen of parastomal hernia and extraction of 40 cm. of small bowel located in parastomal hernia were performed. The parastomal hernia defect were identified and measured. We used a 15 cm x 20 cm flexible composite mesh. The fine filament design and its macroporous structure flexible, facilitate the scar tissue formation and adaptation to the abdominal wall. Several takers are placed in the abdominal wall, circumferentially around the ileal loop using a 5-mm tacking device . The patient was discharged after a 2-day stay. After 20 months of follow up, the patient is free of recurrence of parstomal hernia.

Conclusions: The introduction of prosthetic meshes significantly decreases the recurrence rates of parastomal hernia. Laparoscopic surgery reduces postoperative pain, recovery time and minimize many of the morbidities associated with open procedures.