A Case of Laparoscopic Sugarbaker Repair of a Parastomal Hernia Using a Shaped Mesh

Abstract

The patient was a 60-year-old man who had previously undergone Hartmann's procedure. He was referred to our department for surgery to treat a parastomal hernia the size of a child's head. The hernia was repaired laparoscopically using Sugarbaker's procedure. The hernia orifice was 8-cm long, and since the inferior epigastric artery and vein were involved on the caudal side, peritoneal dissection was required. A Symbotex^TM composite mesh was folded so that it measured 18 cm overall with a 14-cm folded portion, and it was positioned so that an adhesion-preventing collagen film on the folded part covered the stomal intestinal tract. Parastomal hernias are reported to have a low recurrence rate after Sugarbaker's procedure, but the mesh used for this procedure is not yet commercially available in Japan. Cases in which Symbotex^TM composite mesh has been shaped for use as an alternative have been reported, and in the present case, the repair was carried out using this method. Our mesh-shaping method and intraoperative points to note are reported.