Open retromuscular keyhole for parastomal hernia repair after ureteroileostomy: surgical technique and long-term outcomes.

Abstract

<h4>Background</h4>Parastomal hernia (PSH) repair following ureteroileostomy (Bricker's technique) presents unique anatomical challenges, as short ileal conduits often preclude safe stoma lateralization. This study describes the open surgical technique and long-term outcomes of a retromuscular repair utilizing transversus abdominis release (TAR) and a keyhole mesh configuration.<h4>Methods</h4>We conducted a retrospective analysis of a prospective institutional registry including all consecutive patients undergoing elective open PSH repair after ureteroileostomy between 2019 and 2023. All procedures utilized an open retromuscular keyhole mesh placement with a right-sided TAR. Primary outcomes included 30-day complications (Clavien-Dindo classification) and long-term recurrence.<h4>Results</h4>Fourteen male patients (mean age 75.4 years; mean BMI 28.0 kg/m²) were included. Concomitant midline hernias were present in 42.9% (6/14). The overall 30-day complication rate was 57.1% (8/14), primarily consisting of seromas (5/14) and surgical site infections (3/14). One ureteral injury (7.1%) occurred, requiring nephrostomy (Grade III). At a median follow-up of 42.7 months (IQR: 32.8-48.7), with an 85.7% (12/14) CT surveillance rate, the recurrence rate was 14.3% (2/14). Only one patient required surgical reintervention for recurrence.<h4>Conclusion</h4>The retromuscular keyhole technique for parastomal hernia repair following ureteroileostomy is feasible but carries high perioperative morbidity, and comparable long-term recurrence to other studies. Randomized trials are required to provide a higher level of evidence.