Department of Urology, University of Minnesota; Minneapolis, MN.
Department of Urology, University of Minnesota; Minneapolis, MN.
Urology. 2021 Jun;152:199. doi: 10.1016/j.urology.2021.01.020. Epub 2021 Jan 20.
Parastomal and ventral hernias are common complications in patients with continent catheterizable channels or incontinent urinary diversions. Patients with neurogenic bladder are at particularly high risk due to weak abdominal wall musculature, and hernia repair often requires resiting of their stoma. While parastomal hernia repair with urinary stoma resiting has acceptable long-term success rates, it often necessitates a laparotomy which is associated with significant morbidity.
To describe a novel approach to combined laparoscopic parastomal hernia repair with resiting of the urinary stoma in patients with neurogenic bladder. The video will outline the surgical steps and pitfalls.
The case begins laparoscopically or robotically with adhesiolysis to dissect out the subfascial portion of the channel and the parastomal hernia. The subfascial portion of the channel is dissected out to the anterior abdominal wall, ensuring to preserve its mesentery. The abdomen is then desufflated and the suprafascial portion of the channel is dissected and the channel dropped into the abdomen. The hernia is then repaired laparoscopically using mesh and the channel is brought out through one of the laparoscopic port sites and matured to the skin.
In our series of 4 patients, this technique was performed for 2 continent catheterizable channels and 2 incontinent diversions. One patient developed a hernia recurrence 7 months later which was repaired laparoscopically. In another, the stoma was successfully resited but the hernia was unable to be repaired laparoscopically due to dense adhesions. Continent and patency outcomes of the urinary stomas were 100% at a mean follow-up of 2 years.
Laparoscopic parastomal hernia repair with resiting of the urinary stoma has similar long-term success rates compared to that of an open repair and avoids the morbidity of a laparotomy. This repair can be performed for catheterizable channels or incontinent diversions.
在使用可控性膀胱造口术或不可控性尿流改道术的患者中，造口旁疝和腹疝是常见的并发症。由于腹壁肌肉薄弱，神经源性膀胱患者发生疝的风险特别高，疝修补术常需要重新定位造口。虽然带尿路造口转移的造口旁疝修补术具有可接受的长期成功率，但通常需要剖腹手术，这与显著的发病率相关。
描述一种治疗神经源性膀胱患者带尿路造口转移的腹腔镜下联合造口旁疝修补术的新方法。该视频将概述手术步骤和陷阱。
该病例首先通过腹腔镜或机器人手术进行粘连松解，以解剖出皮下通道部分和造口旁疝。将皮下通道部分解剖到前腹壁，确保保留其系膜。然后排空腹部，解剖皮下通道部分，将通道放入腹部。然后通过腹腔镜端口之一将疝腹腔镜下修补，并用网片修复，并将通道带出皮肤成熟。
在我们的 4 例患者系列中，这项技术用于 2 例可控性膀胱造口术和 2 例不可控性尿流改道术。1 例患者在 7 个月后出现疝复发，经腹腔镜修补。在另一个病例中，造口成功转移，但由于粘连致密，无法进行腹腔镜下修补。在平均 2 年的随访中，尿路造口的通畅和控尿效果为 100%。
与开放修补术相比，腹腔镜下带尿路造口转移的造口旁疝修补术具有相似的长期成功率，避免了剖腹手术的发病率。这种修复术可用于可控性膀胱造口术或不可控性尿流改道术。
