The Edinburgh approach to the Pauli technique for isolated parastomal hernias without midline component

Parastomal hernia (PSH) is a common complication of stoma formation, and there is no consensus on the optimal surgical treatment of this challenging condition. In this technical note, our aim is to describe a novel approach by carrying out a Pauli repair through the stoma, thereby avoiding a midline laparotomy, and to evaluate its outcomes in a case series.

We provide a description and video of the technical steps of this novel approach. In addition, we carried out a retrospective single-centre case series of six consecutive elective patients treated with this technique for PSH without a midline component and their immediate procedural outcomes (recurrence and complications).

Six patients with a mean age of 56.8 years (range 39-72 years) and a mean BMI of 30.3 kg/m² underwent this modified Pauli repair between 2023 and 2025. Three patients (50%) had European Hernia Society (EHS) type III hernias. Median length of stay was 3.5 days (IQR 3-4.75). There were no Clavien Dindo ≥4 complications but a high rate (50%) of wound complications. We observed no clinical recurrences at a median follow-up time of 13.6 months (IQR 7.9-20.2 months).

Our modification of the Pauli technique for hernias without a midline component is feasible with promising short-term results in patients with an ileal conduit. Further evaluation in larger cohorts with longer follow-up is required to establish the safety and durability of this approach.

This paper describes the feasibility of carrying out a Pauli repair of parastomal hernia via a local approach through the stoma, thereby avoiding the morbidity of a laparotomy in patients without a midline component. Further evaluation in larger cohorts with longer follow-up is required to establish the safety and durability of this approach.