Endoscopic totally extraperitoneal repair for parastomal hernia using the ePauli technique

This study aimed to evaluate the feasibility, safety, and short- to medium-term clinical outcomes of a standardized pure laparoscopic totally extraperitoneal (eTEP)-based endoscopic Pauli (ePauli) technique for parastomal hernia (PH) repair.

A prospective analysis was conducted on 13 consecutive patients who underwent standardized eTEP-based ePauli repair for PH at our institution. Baseline clinical characteristics, perioperative parameters, and short- to medium-term postoperative outcomes were collected and analyzed.

The cohort had a mean age of 72 ± 7.0 years (9 males, 4 females), with 61.5% classified as American Society of Anesthesiologists (ASA) grade 2 and 76.9% presenting with cardiovascular comorbidities. The mean PH defect diameter was 5.7 ± 1.6 cm, mean operative time was 245.9 ± 51.2 min, and median postoperative hospital stay was 7 days (range: 4-65 days). Postoperative complications included cholecystitis, surgical site infection, hematoma, and mesh infection (one case each, 7.7%), as well as intestinal obstruction (three cases, 23.1%). No seromas were observed. Two patients (15.4%) required secondary surgical intervention, and short-term recurrence was observed in one patient (7.7%) following mesh removal. All complications were successfully managed with targeted interventions, and all patients achieved uneventful recovery.

The pure laparoscopic eTEP-based ePauli technique is a feasible and safe minimally invasive option for parastomal hernia repair, offering acceptable short- to medium-term outcomes. Although not universally applicable to all patients or surgeons, it constitutes a valuable and effective addition to the armamentarium for parastomal hernia repair.