Prof. Marek Szczepkowski is the head of the Department of General and Colorectal Surgery of Bielański Hospital in Warsaw, one of the most experienced surgical departments in parastomal hernia repair in Poland.
Several surgical techniques of parastomal hernia repair have been described. Currently, the Sugarbaker technique, described in 1980, and the sandwich technique, which was first described by Berger, are the most common for surgical repair [1, 2]. The laparoscopic approach to parastomal hernia repair seems to be superior to the open approach due to its lower rate of recurrence and lower rate of postoperative complications, and this method was suggested by Hansson et al. [3]. Laparoscopy in other hernia repair regions has been advocated for many times by numerous surgeons, including in the pages of Videosurgery, and it was extremely encouraging that the Hybrid Operation was used by a team of Prof. Szczepkowski in parastomal hernia repair [4, 5].
Polish surgeons’ contribution to the development of this very difficult field of hernia repair surgery is very visible. The classification currently in force and suggested by the European Hernia Society (EHS) takes into account the experience of the center which is headed by Prof. Szczepkowski [6, 7]. From this center there have been published several papers concerning the experience of Bielański Hospital. During the consensus meeting on Parastomal Hernia Repair in Gdansk in 2011, the Working Group of Polish specialists in this domain was established. The goal of this group was to give a recommendation and the proper approach to this surgical problem, which is very difficult to resolve. This consensus was published in the Polish Journal of Surgery as a contribution to further discussion and studies and is still the indicator for many surgeons [8].
This original paper presents a prospective single center and single surgeon study which shows early results of the novel concept of the minimally invasive surgical technique of parastomal hernia repair – the HyPER technique (Hybrid Parastomal Endoscopic Re-do). It also contains a short review of the most popular methods of resolving this difficult surgical problem.
This technique consists of three main parts: the initial, laparoscopic part (adhesiolysis of the region of the ostomy and hernia sac; the next part – open technique (excision of stoma and hernia sac, intraperitoneal placement of special, dedicated for parastomal hernia intraperitoneal on-lay mesh (IPOM) with a funnel and creation of a new stoma with narrowing of the hernia orifice); and the third part – a return to laparoscopy with fixation of this special mesh to the abdominal wall by tacks.
According to the initial results this new technique is very promising because it combines the advantages of the open and laparoscopic approach.
The authors believe that factors such as narrowing the fascia aperture and removal of the hernia sac have greatly attributed to reduction of the recurrence rate of parastomal hernia. Another important factor is adequate mesh selection. Nevertheless, further studies need to be conducted to confirm this thesis in the context of a large group of patients and long-term follow-up.
Conflict of interest
The authors declare no conflict of interest.
References
1. Sugarbaker PH. Prosthetic mesh repair of large hernias at the site of colonic stomas. Surg Gynecol Obstet 1980; 150: 576-8.
2. Berger D, Bientzle M. Laparoscopic repair of parastomal hernias: a single surgeon’s experience in 66 patients. Dis Colon Rectum 2007; 50: 1668-73.
3. Hansson BME, Slater NJ, Schouten van der Velden AP, et al. Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 2012; 255: 685-95.
4. Białecki JT, Wieloch MM, Kołomecki K. Single incision approach to totally extraperitoneal inguinal hernia repair. Videosurgery Miniinv 2014; 9: 201-6.
5. Pielaciński K, Szczepanik A, Wróblewski T. Effect of mesh type, surgeon and selected patients’ characteristics on the treatment of inguinal hernia with the Lichtenstein technique: randomized control trial. Videosurgery Miniinv 2013; 8: 99-106.
6. Smietański M, Szczepkowski M, Alexandre JA, et al. European Hernia Society classification of parastomal hernia. Hernia 2014; 18: 1-6.
7. Gil G, Szczepkowski M. A new classification of parastomal hernias – from the experience at Bielański Hospital in Warsaw. Pol Przegl Chir 2011; 83: 430-7.
8. Śmietański M, Bury K, Matyja A, et al. Polish guidelines for treatment of patients with parastomal hernia. Pol Przegl Chir 2013; 85: 152-80.
Received: 15.01.2015, accepted: 15.01.2015.
Copyright: © 2015 Fundacja Videochirurgii This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
