PMC4919719_01
a) The patient had a large parastomal hernia in the left lower abdomen and an ileal conduit in the right lower abdomen. b) Abdominal CT scans showed a large parastomal hernia of a stoma with herniation of transverse colon.
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She presented with a parastomal hernia of a stoma in the left lower abdomen and an ileal conduit in the right lower abdomen (Fig. 1a). Abdominal CT scans showed a large parastomal hernia of a stoma with prolapse of the transverse colon (Fig. 1b).
Positioning of trocars, operator, and equipment for the laparoscopic surgery.
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Three ports were placed as follows: a 12-mm trocar on the right side of the umbilicus for a flexible laparoscope; a 12-mm trocar in the right subcostal region; and a 5-mm trocar in the right lower quadrant, while taking care to avoid injuring the ileal conduit (Fig. 2).
Laparoscopic views of operation procedures.. a) Laparoscopic views of a parastomal hernia and an ileal conduit. b) Greater omentum and transverse colon protruded into the hernia sac. c) A parastomal fascial gap was completely freed. Dotted line indicates a parastomal fascial gap.
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In this case, these trocars needed to be placed at more cranial position than usual because of an ileal conduit (Fig. 3a). A parastomal fascial gap was completely freed from the greater omentum and transverse colon, which protruded into the hernia sac (Fig. 3b and c).
Operation procedures of the sandwich technique.. a) Composite mesh was applied by the keyhole technique. Laparoscopic views (left) and its illustration figures (right). b) A further mesh (central band type) was overlaid to cover the first mesh and the whole abdominal wall by the Sugarbaker technique. Laparoscopic views (left) and its illustration figures (right). In illustration figures (right), purple lines represent stay sutures, while blue circles do absorbable tacks.
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A mesh (hole type) incised to the center was placed around the stoma to cover the orifice of parastomal hernia using the keyhole technique (Fig. 4a). Afterwards, a further mesh (central band type) was overlaid to cover the first mesh and the whole abdominal wall by the Sugarbaker technique (Fig. 4b).
Abdominal CT scans showed no recurrence for more than 3 years after surgery.
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She has been followed up for more than 3 years without any signs of recurrence (Fig. 5).