Totally endoscopic sublay/extraperitoneal (TES)-Sugarbaker repair for type IV parastomal hernia

The totally endoscopic sublay/extraperitoneal (TES) technique has become a substantial supplement for the treatment of ventral hernias. The fundamental principle of this technique is to break down the boundaries and connect the spaces, then create a sufficient sublay/extraperitoneal space for hernia repair and mesh placement. This video demonstrates the surgical details of the TES operation for an EHS type IV parastomal hernia. The main steps include retromuscular/extraperitoneal space dissection in the lower abdomen, circumferential incision of the hernia sac, stomal bowel mobilization and lateralization, closure of each hernia defect, and final mesh reinforcement.

The operative time was 240 min, and no blood loss occurred. No significant complications were noted during the perioperative period. Postoperative pain was mild, and the patient was discharged on postoperative day 5. During the half-year follow-up, no recurrence or chronic pain was detected.

The TES technique is feasible for carefully selected difficult parastomal hernias. To our knowledge, this is the first reported case of endoscopic retromuscular/extraperitoneal mesh repair of a challenging EHS type IV parastomal hernia.