How to do a laparoscopic modified Sugerbaker Technique in an Ileal Conduit (Bricker) parastomal hernia

N. Ruyssers, B. Defoort, L. Balliu, G. Hubens

Moderator(s): Gert Jan Kleinrensink (Rotterdam, The Netherlands) & Todd Heniford (Charlotte, USA)

9:45 - 10:00h at Jurriaanse Zaal

Categories: Session 5. Parastomal hernia surgery

Parallel session: Session 5. Parastomal hernia surgery

As parastomal hernia (PSH) is a common complication after stoma formation, every abdominal surgeon will have to deal with this pathology during their career. The laparoscopic modified Sugarbaker technique (LMST), a relatively new technique, has been proposed as a safe procedure with low recurrence rates.
We present a video of a patient with PSH after radical cystectomy with ileal conduit for bladder cancer. Because of incarceration of the caecum, a semi-urgent LMST was performed. Based on our practice and on literature, we demonstrate the surgical key elements with attention to some pearls and pitfalls for the unexperienced surgeon.
Pneumoperitoneum was obtained using a Veress needle. Three trocars were placed on the anterior axillary line opposite the stoma-site. As handling of instruments can be difficult, we emphasize to place trocars as lateral as possible with sufficient distance in between.
Adhesiolysis should be obtained using sharp dissection since blunt dissection or electrocoagulation can lead to bowel perforation. Careful reduction of stomal content was performed because faecal contamination dissuades placing a mesh . A Foley balloon-catheter placed into the ostomy, helped to identify the ileal conduit.
We preferred to use Parietex composite parastomal mesh® (Covidien) designed for PSH repair as the bowel can be visualised due to its transparency.
The risk of recurrence is reduced by appropriate fixation of the prosthesis. The hernia defect should be measured while insufflated, mesh size while desufflated. We suggest to place 4 transfascial sutures on the edges of the mesh and further fixation by tackers placed according to the Double-Crown method.
Although the LMST is relatively easy acquired, standardization of the technical aspects needs to be elaborated in our centre. As young surgeons are lacking routine - considering the infrequent performed procedure - we believe that these practical tips can help shorten their learning curve.