Robotic Pauli repair of parastomal hernia

Abstract Background Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The accounts aim is to report mid-term results with this method.Methods Patients operated for PH were enrolled in a prospective study. Patients with concomitant midline hernia also had Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket – except PTFE was chosen for inflammatory bowel disease patients.Results Of 53 included ostomates 43 had colostomies, 8 ileostomies and 2 urostomies, all end-type. 40% had a concomitant hernia and 26% had recurrent PH. Mean operating time without accessory repair was 156 minutes (SD 37) and with accessory repairs 220 minutes (SD 62). Postoperative complications ensued in 12 patients (23%). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative revision of the stoma without postoperative morbidity. One patient had late stoma necrosis and was relocated after 3 weeks. One patient had a mesh infection, 3 patients suffered temporary ileus and one hypovolemic renal failure, one of two patients with flare-up of their IBD. One parastomal abscess had with percutaneous drain. The median postoperative stay was 3 days (1–21; mean 3.7 days) and the readmission rate was 7.5%. The recurrence rate at mean and median 24 months follow up is 3.8%, both in ileostomy patients.Conclusions Robotic Pauli repair shows promising results. However, the repair fails with short mesentery in small bowel ostomies. ePauli/TAR is now the standard operation for all eligible patients at our site.