Modified Pauli's Ileal Conduit Parastomal Hernia Repair

Ileal conduit parastomal hernia post robotic cystoprostatectomy with recurrent subileus treated conservatively. Concomitant left inguinal hernia with digestive content, evolving Mc Burney extraction site hernia, small umbilical and midline 5mm trocar hernia. Single left upper quadrant 3 trocar docking without assistant trocar. ICG (*brand hidden*) to assess vascularisation and anatomy of the ileal conduit. Combined dissection started TAPP on the left side, modified Cross-Over to right retro-rectus space, unilateral right TAR, primary reconstruction with plication of the hernia sac, primary prosthetic mesh reinforcement of the reconstruction. Modified Pauli's repair with custom sized and shaped 30x30 macroporous monofilament mesh to reinforce at the mean time underlying extraction site Mc Burney incisional hernia. Double mesh on the reconstructed parastomal hernia site acts as custom "Central Mesh Densification". Left direct inguinal hernia is adressed in the same docking. Purse string closure of peritoneal rents.