Feasibility of Hybrid Double-Layered Mesh Repair for Parastomal Hernia: Laparoscopic Intraperitoneal Underlay Combined with Gasless Laparoscopic Subcutaneous Anterior Fascial Overlay

PURPOSE: This study aimed to describe and evaluate a novel hybrid double-layered mesh repair for parastomal hernia (PSH), in which two mesh layers are placed in anatomically distinct and separate planes to maximize reinforcement while minimizing intraperitoneal mesh-mesh contact. METHODS: Sixteen patients undergoing hybrid double-layered mesh repair for PSH between January 2020 and February 2026 were retrospectively analyzed. The technique combines an intraperitoneal underlay mesh (expanded polytetrafluoroethylene or biomesh) positioned with the Sugarbaker technique via standard laparoscopy, and a subcutaneous anterior fascial overlay mesh (polypropylene, keyhole configuration) placed via a gasless laparoscopic-assisted approach through a short midline incision. The procedure alternates between four laparoscopic and gasless phases. Eleven patients (11/16, 68.8%) underwent concomitant procedures. The median operative time was 203 minutes and median blood loss was 75 mL. Four patients (4/16, 25.0%) experienced postoperative complications, including stoma malfunction in two (2/16, 12.5%) and wound seroma in one (1/16, 6.3%). No mesh-related infection or PSH recurrence occurred over a median follow-up of 30.3 months (interquartile range 11.9-53.7 months). CONCLUSION: This hybrid technique achieves anatomical separation of the two mesh layers-distinguishing it from the conventional sandwich technique-and demonstrates promising early outcomes with zero recurrence and zero mesh infection. The approach represents a feasible and potentially durable option for PSH repair, though prospective multicenter studies with longer follow-up are warranted.