Application of "multidimensional suture" technique in laparoscopic Sugarbaker repair of parastomal hernia
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1.Department of General Surgery (Hernia and Abdominal Wall Surgery), the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China;2.Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, China;3.Guangzhou Zhongliu Biomedical Innovation Center, Guangzhou 510655, China

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R656.2

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    Abstract:

    Background and Aims Parastomal hernia is a common complication following intestinal stoma creation. The laparoscopic Sugarbaker procedure is currently the mainstream surgical approach, and the biggest challenge lies in how to suture and close the fascial defect. Conventional suture closure techniques have limitations such as difficulty in closing or reducing the defect, high incidence of postoperative seroma formation, and poor abdominoplasty outcome. In our center, we have successfully addressed these issues by utilizing the " multidimensional suturing" technique to close the defect. This study was performed to compare the clinical efficacy of the "multidimensional suture" technique with conventional suture technique in the laparoscopic Sugarbaker repair of parastomal hernia, to assess the clinical value of the "multidimensional suture" technique in parastomal hernia repair.Methods The data of patients with parastomal hernia who underwent laparoscopic Sugarbaker repair in the Department of Hernia and Abdominal Wall Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to December 2021 were retrospectively analyzed. Of the patients, 44 cases received a "multidimensional suture" for the treatment of hernia sac and defect (study group), and 29 cases underwent the conventional suture method for the defect closure (control group). The main clinical variables were compared between the two groups of patients.Results The fascia defects were completely closed in all patients in the study group, while 9 patients (31.0%) failed to achieve complete defect closure in the control group. The average time for fascial defect closure was (47.45±10.44) min in the study group and (33.72±8.64) min in the control group. The average operative time was (132.14±13.72) min in the study group and (113.97±18.30) min in the control group. The differences in these variables between the two groups were statistically significant (all P<0.001). The postoperative seroma formation rate in the study group was significantly lower than that in the control group (6.8% vs. 27.6%, P=0.036). The incidence of mesh infection after surgery showed no statistically significant difference between the two groups (2.3% vs. 3.4%, P=0.640). The study group had a significantly lower postoperative recurrence rate compared to the control group (2.3% vs. 20.7%, P=0.027). The postoperative hospital stay was 6 (5-7) d in both the study and control groups, and the hospital costs were (72 998.79±15 352.46) yuan and (72 998.79±11 542.77) yuan in the study group and the control group, respectively. There were no statistically significant differences in these two variables between the two groups (P=0.447, P=0.708).Conclusion Applying the "multidimensional suture" technique in laparoscopic Sugarbaker repair of parastomal hernia can effectively close the fascia defect and reduce the risk of postoperative seroma and recurrence.

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HOU Zehui, YU Zhuomin, LIANG Zhiqiang, LI Yingru, ZENG Bing, CHEN Shuang, JIANG Zhipeng, ZHOU Taicheng. Application of "multidimensional suture" technique in laparoscopic Sugarbaker repair of parastomal hernia[J]. Chin J Gen Surg,2023,32(10):1491-1498.
DOI:10.7659/j. issn.1005-6947.2023.10.007

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History
  • Received:February 28,2023
  • Revised:April 06,2023
  • Adopted:
  • Online: November 02,2023
  • Published: