Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida, 25198, Catalonia, Spain.
General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
Hernia. 2024 Dec;28(6):2235-2243. doi: 10.1007/s10029-024-03152-3. Epub 2024 Aug 30.
The modified retromuscular Sugarbaker or Pauli technique is a technique for parastomal hernia repair, which requires the dissection of the retromuscular space and a transversus abdominis release for stoma lateralization and placement of a retromuscular mesh. Given the limited evidence regarding the robotic approach to this technique, this study aims to evaluate the outcomes of this newly introduced procedure, focusing on the rate of 30-day complications and recurrence rates.
Retrospective case series report. Patients included underwent an elective robotic modified retromuscular Sugarbaker technique for the repair of a parastomal hernia associated with an end colostomy. All surgeries were performed at a tertiary referral center from September 2020 to December 2023.
A total of 21 patients underwent a robotic modified retromuscular Sugarbaker in our study. The parastomal hernias operated on were classified according to the European Hernia Society as 9.5% (2/21) type I, 52.4% (11/21) type II, 23.8% (5/21) type III, 14.3% (3/21) type IV. Early complications observed included 14.3% (3/21) seroma, 9.5% (2/21) surgical site infection, 19% (4/21) postoperative ileus, and one case of large bowel obstruction due to colitis (4.8%), which was managed conservatively. No Clavien-Dindo grade III complications were reported. The overall recurrence rate was 9.5% (2/21) with a median follow-up of 12.5 months (IQR: 3.9-21.3). Both recurrences occurred during the early phases of the learning curve and were possibly attributed to insufficient lateralization of the stoma.
Robotic modified retromuscular Sugarbaker for parastomal hernia repair is a challenging procedure with promising early outcomes.
改良的经肌肉后入路 Sugarbaker 或 Pauli 技术是一种用于治疗造口旁疝的技术，需要解剖肌肉后间隙，并进行腹横肌松解以实现造口侧方移位和放置肌肉后网片。鉴于该技术的机器人方法的有限证据，本研究旨在评估该新技术的结果，重点关注 30 天并发症和复发率。
回顾性病例系列报告。纳入的患者接受了择期机器人改良经肌肉后入路 Sugarbaker 技术治疗与末端结肠造口相关的造口旁疝。所有手术均在 2020 年 9 月至 2023 年 12 月在一家三级转诊中心进行。
本研究共 21 例患者接受了机器人改良经肌肉后入路 Sugarbaker 手术。手术治疗的造口旁疝根据欧洲疝学会分类为 9.5%（2/21）I 型、52.4%（11/21）II 型、23.8%（5/21）III 型、14.3%（3/21）IV 型。早期并发症包括 14.3%（3/21）血清肿、9.5%（2/21）手术部位感染、19%（4/21）术后肠梗阻和一例因结肠炎引起的大肠梗阻（4.8%），均保守治疗。无 Clavien-Dindo 分级 III 级并发症报告。总体复发率为 9.5%（2/21），中位随访时间为 12.5 个月（IQR：3.9-21.3）。两次复发均发生在学习曲线的早期阶段，可能归因于造口的侧方移位不足。
机器人改良经肌肉后入路 Sugarbaker 技术治疗造口旁疝是一种具有挑战性的手术，早期结果有希望。
