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P004: PUSHING BOUNDARIES IN MINIMALLY INVASIVE ABDOMINAL WALL SURGERY: ROBOTIC REPAIR OF A RECURRENT VENTRAL AND PARASTOMAL HERNIA IN THE RETROMUSCULAR PLANE.
Maxime Dewulf, MD1; Filip Muysoms, MD, PhD2; 1MUMC+ Maastricht, Netherlands; 2AZ Maria Middelares, Ghent
With this submission we aim to illustrate how robotic surgery helps to expand indications of minimally invasive surgery in abdominal wall repair. Extensive video illustrations show a robot-assisted combined repair of a recurrent ventral and parastomal hernia in the retromuscular plane.
Our 56-year-old female patient, with a medical history of type II diabetes, presented with an extensive history of abdominal wall surgery. Because of uncontrollable and refractory faecal incontinence, an end colostomy was created in her left flank in 2012 through a midline laparotomy. In 2013, an open Sugarbaker repair of a parastomal hernia was performed, using intraperitoneal mesh. Because of a midline hernia, an intraperitoneal repair was performed in 2014. In 2017, our patient underwent an open adhesiolysis through the midline mesh. During this procedure, both meshes were sutured together using non-absorbable stitches. She presented at our outpatient clinic with obstructive symptoms, due to a recurrence of her parastomal hernia. Preoperative Computed Tomography (CT) scan illustrated a recurrence of her ventral hernia, and confirmed the recurrent parastomal hernia.
Using a lateral three-trocar approach in the right flank, a robot-assisted exploration was undertaken. After extensive adhesiolysis, both intraperitoneal meshes – along with their tackers - were removed. A combined ventral and parastomal hernia repair in the retromuscular plane was performed after bilateral Transversus Abdominis Release (TAR). For the treatment of the recurrent parastomal hernia the retromuscular Sugarbaker technique, as described by Eric Pauli, was used. The postoperative course remained uneventful. There was a rapid recovery of transit with stool passing through the stoma on day 2 postoperative, and an adequate analgesia using traditional painkillers. Our patient was discharged on day 5 postoperative.
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