Modified Sugarbaker Procedure

Parastomal Hernia

FEREDUN!!!
Azari
Background

Incidence of parastomal hernias after

Ileostomy 36%
Colostomy 48%
Most are evident within 2 years of operation
Repair of Hernias

The options for the surgical management :

Primary fascial repair (4676% recurrence rate)

Stomal relocation: (incisional hernia at the old site,

new parastomal hernia at new site)

Placement of varying types and shapes of mesh

Depending on technique and placement, recurrence rates
after mesh repair varied between 6.9 and 17.8 %. The
overall mesh infection rate was 2.4 %
Sugarbaker, 1985
nonslit polypropylene mesh is placed intraperitoneally over
the hernia with lateralization of the bowel
VIA Laparotomy
7 patients
No recurrence in 4 years
Laparoscopy and modified Sugarbaker
laparoscopic repair of the stomal hernia with a nonslit mesh
covering the hernia defect
With at least a 5-cm overlap; with lateralization of the
colon/ileum going into the stoma,

Treatment has been shown to have the lowest rates of

recurrence
Overall Results

The laparoscopic Sugarbaker technique is a safe procedure

for repairing parastomal hernias.
In Hansson et al (2014)
the overall morbidity was 19 %
the recurrence rate was 6.6 % after a mean follow-up of 26
months.
Moreover, the laparoscopic approach revealed concomitant
hernias in 41 % of the patients, which could be repaired
successfully at the same time.
Recurrence
The recurrence rate was 16.6% for the modified Sugarbaker
technique,
compared with 61% for keyhole repair,
69.2% for ostomy relocation,
33.3% for open repair (P value < .001).
Median follow-up was 16.6 months, 19.6 months, 16.4
months, and 27.2 months
Disease Free Time
Using the Kaplan-Meier method,
80% of Sugarbaker patients would be recurrence free at 2
years
Vs about 60% of those in the other groups (log-rank P= .
021),
References
1. Carne PWG, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg. 2003;90:784793 [PubMed]
2. Pearl RK. Parastomal hernias. World J Surg. 1994;13:569574 [PubMed]
3. Janes A, Cengiz Y, Israelsson LA. Randomized clinical trial of the use of a prosthetic mesh to prevent
parastomal hernia. Br J Surg. 2004;91:280282 [PubMed]
4. van Sprundel TC., Gerritsen van der Hoop A. Modified technique for parastomal hernia repair in patients
with intractable stoma-care problems. Colorectal Dis. 2005;7(5):445449 [PubMed]
5. Lning TH, Spilllenaar-Bilge EJ. Parastomal hernia: complications of extra-peritoneal onlay mesh
placement. Hernia. 2009;13(5):487490 [PubMed]
6. Vijayasekar C, Marimuthu K, Jadhav V, Mathew G. Parastomal hernia: is prevention better than cure? Use
of preperitoneal polypropylene mesh at the time of stoma formation. Tech Coloproctol. 2008;12(4):309
313 [PubMed]
7. Sugarbaker PH. Prosthetic mesh repair of large hernias at the site of colonic stomas. Surg Gynecol Obstet.
1980;150:576578 [PubMed]
8. Stelzner S, Hellmich G, Ludwig K. Repair of paracolostomy hernias with a prosthetic mesh in the
intraperitoneal onlay position: modified Sugarbaker technique. Dis Colon Rectum. 2004;47:185191