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Page 6 of 10 Berger. Mini-invasive Surg 2023;7:24 https://dx.doi.org/10.20517/2574-1225.2023.30

Table 1. Techniques and results of parastomal hernia repair in Finland
Keyhole Sugarbaker Sandwich Chimney
Frequency of use 16.3% 38.8% 15.4% 8.3%
Recurrence rate 35.9% 21.5% 13.5% 15%

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Figure 2. Keyhole repair as the first step of the “Sandwich technique”. The incised keyhole mesh (Dynamesh ) is put around the
ostomy, closed by two non-absorbable sutures and non-absorbable tacks, and finally fixed every 3 cm at the edge of the mesh.

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Figure 3. Placement of the “Sugarbaker”-mesh. Another Dynamesh is placed above the keyhole mesh in a sandwich-like manner
according to the Sugarbaker technique, covering the area between the midline and, sometimes, to the lateral edge of the keyhole mesh.
So, the stoma-related bowel is fixed between the two meshes for at least 5 cm, better 7 cm.

The next point arising from the Finnish data concerns the variety of techniques used. Together with the low
patient load under non-centralized conditions, it is almost impossible to compare the data of different
techniques. Furthermore, it is unknown whether a special technique is really corresponding to the original
description. In this context, it is worthwhile to have another look on the prevention of parastomal hernia.
The chimney trial is based on a completely standardized mesh implantation procedure , with only one
[31]