Robotically Assisted Repair of a Bilateral Parastomal Hernia

Abstract Introduction We report a case involving a 60-year-old patient who underwent a robotic bilateral parastomal hernia repair utilizing two intraperitoneal funnel meshes. The patient had a history of resection of a leiomyosarcoma situated in the pelvis, resulting in the creation of two artificial bowel orifices via midline laparotomy. These orifices included a descendostomy in the left lower abdomen and an ileum conduit in the right lower abdomen. The CT scan showed a 4,5 × 8 cm MII, MIII, WII incisional hernia of the midline and 3,8 × 5,2 cm parastomal hernia at the site of the ileum conduit and a 3,9 × 4,1 parastomal hernia at the site of the descendostoma. Methods The robotic trocars were placed in the upper abdomen directly under the costal margin. After adhesiolysis and mobilization of the two bowel loops a 16 × 16 cm two intrapertioneal funnel meshes were placed around both stomas. In the lower abdomen, the midline was already covered by the two stoma meshes. In the upper abdomen, an additional 10 × 10 PVDF mesh was placed in order to cover the entire scar. Results The postoperative recovery was uneventful. Because laxative treatment was necessary discharge was delayed. One month after surgery the patient is free of complains and shows no signs of recurrence. Conclusion The management of bilateral parastomal hernias poses technical challenges and is not suitable for traditional procedures involving lateral trocar placement. In cases where cranial or caudal trocar positioning is feasible, the application of an intraperitoneal funnel mesh emerges as an effective approach for addressing bilateral parastomal hernias.