Feasibility of robotic repair of parastomal hernias

Abstract

BACKGROUND: Parastomal hernias present a common complex surgical problem that has a severe clinical impact on quality of life. Several techniques for repair have been described with open or minimally invasive techniques, although recurrence and reoperation continue to be common problems. In the following, a case series utilizing a technique for a minimally invasive repair using the Di Vinci robotic platform for a mesh-reinforced, modified Sugarbaker repair is described. STUDY DESIGN: This study is a retrospective review of 24 cases of robotic-assisted parastomal hernia repairs performed by a single surgeon from 2014 to 2020. Primary endpoints of interest were operative times and length of stay, as well as postoperative complications. RESULTS: Twenty-four patients were included in the study. The average operative time was 194.8 min (range: 95–378 min) and the average console time was 149.5 min (range: 72–319 min). The average length of stay was 3.9 days. No patients required conversion to either a laparoscopic or an open procedure, although two complications required reoperation. Twelve patients developed minor complications, including four who developed a postoperative seroma, but none of them required surgical intervention. CONCLUSIONS: This is the first and largest series describing a technique for a robotic-assisted parastomal hernia repair. This shows that this procedure can be reliably undertaken with the robotic platform with consistent and reproducible results and few complications. Further long-term research will be needed as new robotic techniques evolve and patients will need follow-up regarding recurrence rates and any late complications evaluated.

End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

“…If a suture non-mesh repair is no more recommended except in emergency setting because of the excessive risk of recurrence, mesh augmentation accounting for 90% of PSH repairs is the technique of choice, allowing to significantly reduce the risk of recurrence [ 5 , 13 ]. Minimally invasive repairs, through laparoscopy and more recently by robotic approach [ 14 – 17 ], seem to be the treatment of choice. The objective of this manuscript is to systematically review the current up-to-date evidence concerning minimally invasive techniques focusing on end-colostomy PSH repair in the setting of a laparoscopic or robotic approach.…”