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Case Reports
. 2025 Apr 18;17(4):e82500.
doi: 10.7759/cureus.82500. eCollection 2025 Apr.

Hybrid Open Anterior and Laparoscopic Repair Using Self-Gripping Mesh for Parastomal Hernia Following Ileal Conduit With Extensive Intra-abdominal Adhesions: A Case Report

Yoh Kitamura  1 , Shingo Tsujinaka  1 , Yoshihiro Sato  1 , Tomoya Miura  1 , Chikashi Shibata  1
Affiliations
Case Reports

Hybrid Open Anterior and Laparoscopic Repair Using Self-Gripping Mesh for Parastomal Hernia Following Ileal Conduit With Extensive Intra-abdominal Adhesions: A Case Report

Yoh Kitamura et al. Cureus. .

Abstract

Parastomal hernia (PSH) is the protrusion of visceral organs through an abdominal wall defect adjacent to a stoma and is one of the major complications following cystectomy and ileal conduit (IC) formation. We report a case of hybrid open anterior and laparoscopic repair using self-gripping mesh for a PSH following IC, complicated by extensive intra-abdominal adhesions. An 89-year-old man presented with recurrent episodes of small bowel obstruction (SBO) caused by PSH following IC. The patient had undergone total cystectomy with IC for urinary bladder cancer 30 years prior and had been hospitalized nine times for SBO due to PSH. The patient was referred for surgical treatment. Computed tomography revealed protrusion of the small bowel through a 10 × 7 cm hernia orifice around the IC. Considering the symptomatic PSH with a persistent risk of SBO, laparoscopic repair was planned. Laparoscopic exploration revealed extensive adhesions of the small bowel to the hernia orifice and IC, extending to the pelvis. The IC was also widely attached to the anterior abdominal wall, preventing visual assessment of the contralateral side of the conduit. Therefore, an additional transverse skin incision was made laterally and caudally to the stoma. The defect was closed anteriorly under direct vision with interrupted transfascial sutures and reinforced by onlay mesh placement using a trimmed (15 × 12 cm) self-gripping mesh (ProgripTM, Medtronic). The postoperative course was uneventful. At the 15-month follow-up, the patient was in good physical condition without hernia recurrence or SBO, except for intermittent episodes of urinary obstruction requiring drainage. Hybrid open anterior and laparoscopic repair using self-gripping mesh may be considered a surgical option for PSH following IC with extensive intra-abdominal adhesions around the stoma.

Keywords: ileal conduit; onlay mesh placement; parastomal hernia; self-gripping mesh; small bowel obstruction.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Research Ethics Committee for Life Science and Medical Research, Tohoku Medical and Pharmaceutical University issued approval 2024-4-070-0000. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative computed tomography (CT): Axial view
CT shows protrusion of the small bowel through the hernia orifice. The width of the orifice is 10 cm (yellow arrowheads). The ileal conduit (IC) is located at the internal edge of the hernia orifice, and a urinary catheter is placed for concomitant urinary obstruction (green arrow).
Figure 2
Figure 2. Preoperative computed tomography (CT): Semi-coronal view
CT shows protrusion of the small bowel through the hernia orifice. The width of the orifice is 10 cm (yellow arrowheads).
Figure 3
Figure 3. Position of working ports and skin incision
Schematic presentation of the hernia location (dotted line), opening of the ileal conduit (circle), previous surgical scar (gray line), the wounds with the size of working ports (mm), and the additional skin incision made caudally and laterally to the stoma (transverse red lines). Source: This is our artwork, created using Microsoft PowerPoint software (Microsoft Corp., Redmond, WA, USA).
Figure 4
Figure 4. Intra-abdominal adhesions
Laparoscopic exploration revealed extensive adhesions of the small bowel to the hernia orifice and ileal conduit, extending to the pelvis along the previous midline incision (black arrowheads).
Figure 5
Figure 5. Exposure of the hernia orifice
Schematic presentation shows the location of the ileal conduit, hernia orifice, transverse skin incision, and the dissected area for mesh placement. Source: This is our artwork, created using Microsoft PowerPoint software (Microsoft Corp., Redmond, WA, USA).
Figure 6
Figure 6. Exposure of the hernia orifice
Laparoscopic view of the hernia orifice, measuring 8 × 6 cm in diameter, exposed after adhesiolysis (black arrowheads).
Figure 7
Figure 7. Laparoscopic view of the closed hernia orifice
The defect was closed anteriorly under direct vision (black arrows) to avoid the risk of unintended bowel injury due to intra-abdominal adhesions.
Figure 8
Figure 8. Stoma location and the onlay mesh
Schematic presentation shows the location of the ileal conduit, closed defect, onlay mesh, and dissected area for mesh placement. Source: This is our artwork, created using Microsoft PowerPoint software (Microsoft Corp., Redmond, WA, USA).
Figure 9
Figure 9. Stoma location and the onlay mesh
The onlay mesh was placed beneath the skin incision (black arrowheads). The stoma was protected using surgical drapes during the procedure (yellow arrowheads).
See this image and copyright information in PMC

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