Department of Gastroenterological Surgery, Sykehuset Innlandet Hospital Trust, Furnesvegen 26, N-2380, Brumunddal, Norway.
Surg Endosc. 2021 Apr;35(4):1903-1907. doi: 10.1007/s00464-020-08192-1. Epub 2021 Jan 4.
Aspiring endoscopic surgery with extraperitoneal mesh application to avoid adhesion and pain from mesh fixation, we adopted the principles of the open Pauli repair of parastomal hernia (PSH). We have termed the procedure ePauli repair. The aim of this account is to inform about feasibility and adverse reactions.
Patients with PSH selected for ePauli repair with transversus abdominis release (TAR) were enrolled in a prospective observational study. Patients were operated with laparoscopic or robotic assistance and endoscopic Rives-Stoppa repair in cases with concomitant midline hernia. Coated meshes or a buffer mesh was used in the retromuscular pocket for this modification of the Sugarbaker principle.
Fifteen patients were included: six patients were operated laparoscopically and nine patients with robotic assistance. The median age of the stomas was 33 months (7-313). Five PSHs were recurrent after previous repairs. Median operating time without midline hernia repair was 156 min (107-233) and with midline hernia repair 241 min (176-286). One serosa lesion arose during operation, prompting intraoperative revision of the ostomy without postoperative morbidity. Two patients had postoperative obstruction and were readmitted to operation: one with multiple adhesions and one had kinking of the stoma bowel caused by insufficient incision of the transversalis fascia. No infections or seromas have been observed. One patient had discoloring of the flank with spontaneous remission, and one patient had recurrence. Median postoperative admission time was 3 days (1-19). Median follow-up is 10 months (0-27).
ePauli repair is technically challenging but feasible. With our limited experience, we are encouraged with the pain, complication, and functional summary after ePauli repair and hopeful for the recurrence profile. ePauli/TAR is not for every patient or every surgeon and whether it should be restrained to recurrent PSH or be offered as first-line treatment for PSH is disputable.
为了避免网片固定引起的粘连和疼痛，我们采用了开放的 Pauli 修补术治疗造口旁疝（PSH）的原则，进行了经腹横肌松解（TAR）的内镜下网片修补术（ePauli 修复术）。我们将该术式命名为 ePauli/TAR。本研究旨在报告其可行性和不良反应。
前瞻性观察研究纳入了选择 ePauli/TAR 治疗的 PSH 患者。患者接受腹腔镜或机器人辅助及经腹直肌修补的内镜下 Rives-Stoppa 修补术，如果合并中线疝则同时进行修补。该改良 Sugarbaker 技术使用了涂层或缓冲网片置于腹横筋膜后间隙。
共纳入 15 例患者：其中 6 例接受腹腔镜手术，9 例接受机器人辅助手术。造口的中位年龄为 33 个月（7-313）。5 例 PSH 既往修补术后复发。无中线疝修补时，中位手术时间为 156 分钟（107-233），合并中线疝时为 241 分钟（176-286）。1 例术中出现浆膜损伤，行修补术而无术后并发症。2 例术后出现梗阻，再次手术：1 例为多处粘连，1 例为因腹横筋膜切开不足导致的造口肠袢扭转。无感染或血清肿发生。1 例患者出现腰部色素沉着，自行缓解，1 例患者复发。中位术后住院时间为 3 天（1-19）。中位随访时间为 10 个月（0-27）。
ePauli 修复术技术上具有挑战性，但可行。根据我们的有限经验，我们对 ePauli 修复术后的疼痛、并发症和功能总结感到鼓舞，并对复发情况充满希望。ePauli/TAR 并非适用于所有患者或每位外科医生，是否应仅限于复发的 PSH 或作为 PSH 的一线治疗尚存在争议。
