Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report

Abstract

A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique.

Keywords: endoscopy; parastomal hernia; rectal cancer; surgical repair; totally extraperitoneal repair.

Figure 1

Pre-operative CT scan showing parastomal hernia (yellow arrow).

Figure 2

Layout of the trocar placement.

Figure 3

Anatomic relationship at the end of peritoneal dissociation.

Figure 4

Intraoperative picture of hernia ring closure.

Figure 5

Mesh placement.

Figure 6

Post-operative CT image showing no recurrence of hernia (yellow arrow).

Figure 7

Abdominal wall area. (I) between the rectus abdominis and posterior sheath of rectus abdominis; (II) the Bogros space; (III) Retzius space, and (IV) between the linea alba and peritoneum. (A) between the lateral edge of the posterior sheath of the rectus abdominis and transverse abdominal muscle; (B) between the medial border of the posterior sheath of the rectus abdominis; and (C) between the transverse fascia of the abdomen extending downward and thickening at the outer edge of the arcuate line.