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

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.