Chapter 4 Laparoscopic Repair of Parastomal Hernias
1 Clinical Anatomy
1 Types of Parastomal Hernias
Parastomal hernia has been anatomically classified into four subtypes: (Fig. 4-1)
2 Preoperative Considerations
3 Operative Steps
There are two techniques for laparoscopic repairs of parastomal hernias: the keyhole and the Sugarbaker techniques. Keyhole technique may be associated with bowel herniation between the mesh hole and the stoma loop. We have developed a technique that closes the gap between the mesh and the stoma loop and facilitates intracorporeal mesh manipulations (Scroll technique) during keyhole repairs. The Sugarbaker technique avoids the risk of herniation through the keyhole, but it does create an acute angle as the bowel exits the mesh and can cause obstruction (see Fig. 4-11). Meticulous attention to the details of mesh fixation and placement can limit these complications.