Navigating Recurrent Parastomal Hernia: A Laparoscopic Sugarbaker Approach

Aim To highlight challenges and adverse outcomes in parastomal hernia patients. Material and Methods A 62-year-old woman with recurrent parastomal hernia underwent 8 laparotomies and 5 parastomal hernia procedures. Complications from a fundoplication resulted in a gastric bypass and jejunostomy. Chronic diarrhea led to a sigmoid stoma. Emergency surgeries included incisional hernia repair, laparotomies with mesh removal, and stoma revision. Referral to a specialist center resulted in a Rives-Stoppa and sublay procedure. Subsequent recurrence led to our center. A history of adhesions prompted an onlay approach with an elastic funnel mesh. A CT scan later diagnosed another recurrent parastomal hernia. Results Employing a laparoscopic approach, abdominal access was gained from the right flank using a 5-millimeter optic access port. Dissection of multiple adhesions preceded stoma visualization. The small bowel was mobilized, and hernia defect approximation was done with slowly resorbable continuous sutures. A Sugarbaker procedure with a 15 × 15 cm mesh and absorbable tackers was performed. The patient was discharged one-day post-surgery, with no evidence of recurrence at the three-month follow-up. Conclusions A laparoscopic approach, even in an adherent abdomen, proved feasible. Lateralization of the stoma during the initial surgery is preferable, and centralization of parastomal hernia patients in specialized centres is crucial for optimal management. Multidisciplinary treatment conferences should be considered for these complex cases to ensure comprehensive care. This case emphasizes the importance of a systematic approach and the potential effectiveness of the Sugarbaker technique in managing recurrent parastomal hernias.