Abstract
Background
Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method.
Methods
Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket – except PTFE was chosen for inflammatory bowel disease patients.
Results
Of the 53 included ostomy patients, 43 had colostomies, 8 had ileostomies, and 2 had urostomies, all of which were of the end type. Forty percent had a concomitant hernia, and 26% had recurrent PH. The mean operating time without accessory repair was 156 minutes (SD 37), and that with accessory repairs was 220 minutes (SD 62). Postoperative complications ensued in 12 patients (23%). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative revision of the stoma without postoperative morbidity. One patient had late stoma necrosis and was relocated after 3 weeks. One patient had a mesh infection, 3 patients suffered temporary ileus, one patient experienced hypovolemic renal failure, and one of two patients experienced a flare-up of their IBD. One parastomal abscess was removed with a percutaneous drain. The median postoperative stay was 3 days (1–21; mean 3.7 days), and the readmission rate was 7.5%. The recurrence rate at mean and median 24 months follow up is 3.8%, both in ileostomy patients.
Conclusions
Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the standard operation for all eligible patients at our site.