Early outcomes of laparoscopic total extraperitoneal parastomal hernia repair

INTRODUCTION. Parastomal hernias develop in 40–50 % of patients with a permanent intestinal stoma during long-term follow-up and remain a challenging problem in abdominal wall reconstruction. Laparoscopic total extraperitoneal repair using the ePauli technique allows retromuscular mesh placement; however, evidence regarding its early outcomes remains limited.The OBJECTIVE was to present the preliminary in-hospital outcomes of laparoscopic total extraperitoneal parastomal hernia repair and to perform an exploratory comparison of its perioperative outcomes with open intraperitoneal repair using the modified Sugarbaker technique.METHODS AND MATERIALS. This interim analysis included prospectively collected data from the first 18 patients enrolled in an ongoing multicentre comparative study. The ePauli procedure was initially planned in 15 patients and was completed laparoscopically in 14. One patient required conversion, and the procedure was completed as an open Sugarbaker repair. In the as-treated analysis, the ePauli group included 14 patients and the open Sugarbaker group included four patients, including the converted patient. Operative time, intraoperative blood loss, conversion, complications, and mortality during the index hospitalization were assessed.RESULTS. Median operative time was 118 [96; 162] min in the ePauli group and 113 [98; 154] min in the open Sugarbaker group (p=0.83). Median intraoperative blood loss was 12 [6; 38] and 48 [30; 120] mL, respectively (p=0.061). Conversion with completion of the procedure as an open Sugarbaker repair was required in one patient (6.7 %). Two Clavien–Dindo grade I complications occurred in the ePauli group: a haematoma and pain requiring additional conservative treatment. No major in-hospital complications, reoperations, or in-hospital deaths were recorded.CONCLUSION. In this small prospective series, laparoscopic total extraperitoneal parastomal hernia repair was technically feasible and was not associated with major in-hospital complications. The small sample size, imbalance between the groups, and absence of long-term follow-up preclude conclusions regarding comparative safety, effectiveness, and recurrence.