Laparoscopic Total Extraperitoneal Plasty as a Modification of Sugabecker's Operation

Официальное название

The Laparoscopic Total Extraperitoneal Parastomal Hernia Repair as a Modification of Sugabecker's Operation

Обзор

Abstract: Parastomal hernia is a frequent complication following stoma formation, presenting a significant surgical challenge with high recurrence rates. The present study explores the efficacy of the laparoscopic total extraperitoneal (TEP) approach in parastomal hernia repair, conceived as a modification of the Sugabecker's operation. This prospective work, who analysis aims to evaluate the feasibility, safety, and recurrence rates associated with this minimally invasive technique. Methods: A comprehensive review of patients undergoing laparoscopic TEP parastomal hernia repair between 2024 and 2026 will be performed. Patient demographics, operative details, intraoperative complications, postoperative morbidity, recovery times, and hernia recurrence rates will be collate and analyze. Results: The study will include 30 patients with a median follow-up period of 1month (firstly viewer's point) and 12 months (second view point ). The all of parastomal hernias will associated with colostomies. Early mobilization will achieve, with most patients returning to their routine activities within 2 weeks. Discussion: We anticipate that the data will suggest the laparoscopic TEP technique for parastomal hernia repair is a viable alternative to traditional methods, with a favorable safety profile. The minimally invasive nature of the operation appears to facilitate enhanced recovery while maintaining low recurrence rates. Compared to the original Sugarbaker operation, where the mesh is placed intraperitoneally, the extraperitoneal placement of the mesh in TEP repair minimizes the potential for adhesion formation and related complications. Furthermore, aesthetic outcomes and patient satisfaction reports indicate a positive outlook. Conclusion: The laparoscopic TEP approach for parastomal hernia repair offers a modification to the Sugarbaker operation with potential benefits, including reduced operative morbidity, faster recovery, and potentially lower recurrence rates. Extended follow-up and comparison with the traditional approach are warranted to conclusively establish the long-term outcomes of this technique. This study contributes to the evolving surgical management of parastomal hernias, advancing towards less invasive and more patient-centered treatment modalities.

Подробное описание

Introduction:

Parastomal herniation presents as a common complication following stomal surgeries, creating significant morbidity and adversely impacting the quality of life for patients. Traditional open surgical techniques, including Sugabecker's operation, offer variable success rates and potential complications. This study proposes an adaptation utilizing a laparoscopic total extraperitoneal (TEP) approach, tailored to enhance the original Sugabecker method while aiming to reduce the perioperative morbidity and recurrence rates associated with parastomal hernia repairs.

Objective:

The primary objective of this research is to investigate the laparoscopic TEP parastomal hernia repair as a modification of the Sugabecker's operation and to assess its outcomes in terms of feasibility, safety, and hernia recurrence rate.

Brief Protocol Description:

Eligible candidates who have developed parastomal hernias following stoma creation and consented to the study will undergo laparoscopic TEP repair. The procedure involves an initial unilateral transrectal incision followed by the creation of an preperitoneal or retro-rectus space where a mesh is positioned to reinforce the abdominal wall and the stoma. Also it will has was formed oblique hernia canal. The operative and postoperative outcomes of these patients will be studied in comparison with control group treated with the traditional Sugabecker's operation.

Scientific Hypothesis:

The hypothesis underpinning this research is that a laparoscopic TEP approach to parastomal hernia repair, modifying Sugabecker's procedure, can provide more favorable outcomes, for example: less intraoperative trauma, fewer bowel injuries due to adhesiolysis, and fewer intestinal perforations. Specifically, it is expected that this minimally invasive method will result in a significant reduction in postoperative pain, shorter hospital stays, faster recovery, decreased morbidity, and lower hernia recurrence rates in comparison with the traditional Sugabecker's or Paul's operations.

Expected Results:

This study anticipates that the laparoscopic TEP repair will demonstrate:

1. A safe and reproducible procedure adaptable to different hernia sizes and locations around stomas. 2. Reduced immediate intra - and postoperative complications, including infections and hematoma formation. 3. Quicker patient mobilization and discharge times when compared with the open approach. 4. A statistically significant reduction in parastomal hernia recurrence over a long-term follow-up when matched against controls who have undergone traditional Sugabecker's repair. 5. High patient satisfaction scores and improved quality of life indicators due to the minimally invasive nature of the repair.

In conclusion, through a detailed analysis of perioperative outcomes, long-term follow-up, and comparative studies with traditional methods, this research aims to establish the laparoscopic TEP approach as a superior modification to parastomal hernia repair, upholding the tenets of enhanced recovery and patient-centered care.

Вмешательства

• Процедура standard Sugarbecker's operation
  Eligible candidates who have developed parastomal hernias following stoma creation and consented to the study will undergo laparoscopic TEP repair. The procedure involves an initial unilateral transrectal incision followed by the creation of an preperitoneal or retro-rectus space where a mesh is positioned to reinforce the abdominal wall and the stoma. Also it will has was formed oblique hernia canal. The operative and postoperative outcomes of these patients will be studied in comparison with c
• Процедура modified Sugarbecker's operation
  Eligible candidates who have developed parastomal hernias following stoma creation and consented to the study will undergo laparoscopic TEP repair. The procedure involves an initial unilateral transrectal incision followed by the creation of an preperitoneal or retro-rectus space where a mesh is positioned to reinforce the abdominal wall and the stoma. Also it will has was formed oblique hernia canal. The operative and postoperative outcomes of these patients will be studied in comparison with c

Первичные конечные точки

• Recurrence Rate of Parastomal Hernia [Срок оценки: 1 year post-operation Ensure that the timelines, definitions, and other details reflect the specific procedures and follow-ups that are planned for the clinical trial being discussed.]

Вторичные конечные точки (5)

• Incidence of Infectious Complications at the Surgical Site and Mesh Placement Area [Срок оценки: Assessed at post-operative days 1, 3, 7, 14, and during follow-up visits at 1 month, 3 months, and 6 months]
• Quality of Life Assessment - Short Form Health Survey (SF-36) Score [Срок оценки: Assessed pre-operation and at 3 months, 6 months, 1 year, and 2 years post-operation]
• Length of Hospital Stay [Срок оценки: From date of surgery until hospital discharge, assessed up to 30 days]
• Intra-operative Complications [Срок оценки: During operation]
• Postoperative Pain Levels -Visual Analog Scale (VAS) for Pain [Срок оценки: Assessed at 24 hours, 72 hours, and 7 days post-operation]

Критерии участия

Критерии включения

• Adult patients with a confirmed diagnosis of parastomal hernia post-stoma creation surgery;
• Symptomatic hernias requiring surgical intervention;
• Able to undergo the surgical approach under general anesthesia;
• Patients who can provide informed consent.

Non-Inclusion Criteria:

Patients with contraindications to laparoscopic surgery, such as uncontrolled coagulopathies, severe cardiorespiratory conditions, or extensive intra-abdominal adhesions are excluded. Those with ongoing peritonitis, incarcerated hernias requiring urgent care, or malignancy at the hernia site are also excluded.

Критерии исключения

• Patients unwilling to provide informed consent;
• Patients with a life expectancy less than the study follow-up period;
• Patients who have previously undergone other types of hernia repair, which could confound the operative and postoperative outcomes being measured.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Факторный дизайн

Маскирование

Двойное слепое

Основная цель

Лечение

Центры проведения

Россия · 1 центр

• S.V. Ochapovsky Regional Clinical Hospital #1 — Krasnodar

Идентификаторы

NCT: NCT06474403 · LTEPPHR - 030524

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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