Single-incision laparoscopic parastomal hernia repair employing fascial defect closure and sandwich technique

Akira Umemura, Takayuki Suto, Hisataka Fujuwara, Seika Nakamura, Hiroyuki Nitta, Takeshi Takahara, Yasushi Hasegawa, Akira Sasaki


Parastomal hernia (PSH) is a common complication following stoma creation. However, surgical strategies for PSH are complicated and involve several techniques with different recurrence rates. We hereby present the video of a patient undergoing single-incision laparoscopic PSH repair, employing the fascial defect closure and sandwich technique. The patient was a 76-year-old woman who noticed a reducible non-tender mass around the sigmoid colostomy, and a computed tomography (CT) revealed a PSH measuring 5 cm in size. We performed a single-incision laparoscopic PSH repair employing a fascial defect closure and the sandwich technique. After laparoscopic adhesiolysis of the remnant descending colon, the hernia orifice was closed by non-absorbable 2-0 sutures. We introduced the keyhole mesh into the abdominal cavity and placed it around the colostomy without any gaps. Then, we introduced the Sugarbaker mesh into the abdominal cavity and appropriately placed it after pulling up and fixing the descending colon to the abdominal wall. The patient was discharged on the postoperative day 2 without any complications. Single-incision laparoscopic PSH is technically complex; therefore, employing both a fascial defect closure and the sandwich technique makes the procedure even more difficult. However, this procedure promises minimal invasion and produces very effective surgical results. Further studies and long-term results should further demonstrate the low recurrence rate of this technique.