V-008 Robotic Totally Extraperitoneal Retromuscular Repair of a Type Iii Parastomal Hernia

Abstract

Aim The retromuscular repair described by Pauli et al. (2016) dissects the retromuscular space, releases the transversus muscle, and lateralizes the stoma to place a retromuscular mesh. The aim was to show the results of the robotic approach for this intervention. Material & Methods Video description of a case report. The patient was a 71-year-old woman that underwent an abdominoperineal resection for rectal cancer in 2017 and presented with a 5.8 cm parastomal hernia without midline defects (type III of the EHS classification). Results Three robotic trocars were placed in the lateral of the right rectus sheath, and posteriorly a 12 mm assistance port was inserted in the left hypochondrium. The dissection began in the inferior preperitoneal space, until finding the left transversus muscle. Then, the rectus sheath was dissected superiorly and laterally. A posterior rectus sheath release was performed in a down–to–up direction, initially avoiding the parastomal hernia, which was later reduced. Posteriorly, the peritoneum was incised and then sutured to lateralize the stoma. The parastomal hernia defect and the posterior rectus sheath were equally sutured. Finally, a polyvinylidene difluoride (PVDF) mesh was placed in the retromuscular space, which was fixed with transfascial sutures to the sides of the stoma. Conclusions The robotic totally extraperitoneal retromuscular approach for parastomal hernias is safe and feasible, with the advantage of avoiding the intraperitoneal space.