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Published on: September 11, 2021
Open retromuscular keyhole for parastomal hernia repair after ureteroileostomy: surgical technique and long-term
Alberto G Barranquero1, Jose Carlos Castillo Acosta2, Yolanda Maestre González2
1Abdominal Wall Surgery Unit, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, Lleida, Catalonia, 25198, Spain. agbarranquero.es@gmail.com.
Background:
Parastomal hernia (PSH) repair following ureteroileostomy (Bricker's technique) presents unique anatomical challenges, as short ileal conduits often preclude safe stoma lateralization. This study describes the open surgical technique and long-term outcomes of a retromuscular repair utilizing transversus abdominis release (TAR) and a keyhole mesh configuration.
Methods:
We conducted a retrospective analysis of a prospective institutional registry including all consecutive patients undergoing elective open PSH repair after ureteroileostomy between 2019 and 2023. All procedures utilized an open retromuscular keyhole mesh placement with a right-sided TAR. Primary outcomes included 30-day complications (Clavien-Dindo classification) and long-term recurrence.
Results:
Fourteen male patients (mean age 75.4 years; mean BMI 28.0 kg/m2) were included. Concomitant midline hernias were present in 42.9% (6/14). The overall 30-day complication rate was 57.1% (8/14), primarily consisting of seromas (5/14) and surgical site infections (3/14). One ureteral injury (7.1%) occurred, requiring nephrostomy (Grade III). At a median follow-up of 42.7 months (IQR: 32.8-48.7), with an 85.7% (12/14) CT surveillance rate, the recurrence rate was 14.3% (2/14). Only one patient required surgical reintervention for recurrence.
Conclusion:
The retromuscular keyhole technique for parastomal hernia repair following ureteroileostomy is feasible but carries high perioperative morbidity, and comparable long-term recurrence to other studies. Randomized trials are required to provide a higher level of evidence.
