Robotic sugarbaker parastomal hernia repair: updated series and outcomes.

Purpose: To present updated outcomes after previously describing a novel technique for the robotic repair of parastomal hernias.

Methods: Patients who underwent parastomal hernia repair with a robotic Sugarbaker technique at a tertiary hernia center were identified from an institutional database. The approach involves mesh placement in the intraperitoneal or preperitoneal position after closure of the fascial defect. Baseline demographics, intra-operative variables, and post-operative outcomes were evaluated.

Results: Twenty-six patients were identified who underwent robotic Sugarbaker parastomal hernia repair with mesh. Median age was 61.5 (IQR 58.0-67.0) years, 17 (65%) were male, and median BMI was 29.5 (IQR 25.7-32.6) kg/m. Stoma types included 11 (42%) colostomies, 8 (31%) ileostomies, and 7 (27%) urostomies. All but one case was elective (96%) and 2 (8%) were recurrent. Median operative time was 182.5 (IQR 149-209) min. Biologic mesh was used in 5 (19%) and synthetic mesh in 21 (81%) cases. Concurrent hernia repair was performed in 11 (42%) cases. Two (8%) patients were converted from a robotic to open procedure. Median length of stay was 4 (IQR 3-6) days. A total of 3 (11.5%) patients underwent reoperation related to obstruction at the stoma site. There were no additional 30-day readmissions, seromas requiring intervention, or wound complications. There were 4 (15%) total recurrences during a median follow up of 29.1 (IQR 10.0-55.8) months.

Conclusions: Robotic Sugarbaker parastomal hernia repair is an effective technique for minimally invasive repair of parastomal hernias. Care should be taken to prevent obstruction of the stoma related to fascial and peritoneal flap reconstruction or mesh placement, which is a significant risk of this technique.