A Laparoscopic Approach to Parastomal Hernia Repair With Re-Siting of Urinary Stoma

Background: Parastomal and ventral hernias are common complications in patients with continent catheterizable channels or incontinent urinary diversions. Patients with neurogenic bladder are at particularly high risk due to weak abdominal wall musculature, and hernia repair often requires resiting of their stoma. While parastomal hernia repair with urinary stoma resiting has acceptable long-term success rates, it often necessitates a laparotomy which is associated with significant morbidity. Objective: To describe a novel approach to combined laparoscopic parastomal hernia repair with resiting of the urinary stoma in patients with neurogenic bladder. The video will outline the surgical steps and pitfalls. Materials and Methods: The case begins laparoscopically or robotically with adhesiolysis to dissect out the subfascial portion of the channel and the parastomal hernia. The subfascial portion of the channel is dissected out to the anterior abdominal wall, ensuring to preserve its mesentery. The abdomen is then desufflated and the suprafascial portion of the channel is dissected and the channel dropped into the abdomen. The hernia is then repaired laparoscopically using mesh and the channel is brought out through one of the laparoscopic port sites and matured to the skin. Results: In our series of 4 patients, this technique was performed for 2 continent catheterizable channels and 2 incontinent diversions. One patient developed a hernia recurrence 7 months later which was repaired laparoscopically. In another, the stoma was successfully resited but the hernia was unable to be repaired laparoscopically due to dense adhesions. Continent and patency outcomes of the urinary stomas were 100% at a mean follow-up of 2 years. Conclusion: Laparoscopic parastomal hernia repair with resiting of the urinary stoma has similar long-term success rates compared to that of an open repair and avoids the morbidity of a laparotomy. This repair can be performed for catheterizable channels or incontinent diversions.