Robotic Repair of Parastomal Hernia with Transversus Abdominis Release

Giampaolo Formisano, MD; Sofia Esposito, MD; Giuseppe Giuliani, MD; Adelona Salaj, MD; Lucia Salvischiani, MD; Luca Felicioni, MD; Paolo P. Bianchi, MD

Product Details
Product ID: ACS-5814
Year Produced: 2019
Length: 6 min.


We present a novel technique of robotic parastomal hernia repair with retromuscular mesh reinforcement in a modified Sugarbaker configuration, with posterior component separation and transversus abdominis release (TAR). A 76-year old woman (BMI 26) presented with a 5x5 cm parastomal hernia after abdominoperineal resection (type I-P according to the European Hernia Society Classification). Three 8-mm robotic trocars and a 12-mm assistant port are placed vertically in the right abdominal quadrants. The robot is docked from the patient's left side. The left posterior rectus sheath is opened 0.5 cm lateral to the linea alba to gain access to the retromuscular plane. The plane is followed laterally to the linea semilunaris at the lateral border of the rectus muscle, where the anterior and posterior rectus sheaths fuse. Care is taken to preserve the stoma, the epigastric vessels and neurovascular bundles. The posterior rectus sheath is incised 0.5 cm medially to the neurovascular bundles, exposing the transversus abdominis muscle. TAR is then accomplished gaining access to the preperitoneal plane. The bowel is lateralized and the posterior sheath is closed around the stoma. The hernia defect is closed with barbed suture and the 15 cm partially absorbable polypropylene mesh is placed in the retromuscular space and fixated with cyanoacrylate glue. The ipsilateral posterior rectus sheath is then closed with a barbed suture. Operative time was 220 minutes. Postoperative course was uneventful. Patient was discharged on postoperative day 2. The robotic platform offers several advantages in terms of dissection and primary closure of the defect.