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

Figure 4. A final aspect of the “Sandwich technique”. The final picture demonstrates the stoma-related bowel lateralized between two
meshes and fixed with two rows of tacks beside the intestine for 5 cm.

structure used throughout the study. That should be the way also for the repair of parastomal hernia.

With upcoming robotic use, the range of techniques is even increasing. So, the extraperitoneal Sugarbaker
that requires a transversus abdominis release seems to be very appropriate for robotic use with up to now
[42]
promising results . However, Tastaldi et al., very familiar with any form of component separation
techniques, stopped this technique, done by them in an open approach due to the unacceptable
[46]
complication rate . In 38 patients with a median observation time of 13 months, mesh erosion took place
in three patients (8%), and the recurrence rate was 11%. So, the hype using robotics in all possible cases is
comprehensible but should be used with caution. Furthermore, a strict follow-up of patients treated by new
methods is indispensable.

The last but important aspect concerns the textile structures used for repair as it is in the prevention of
parastomal hernia. As outlined above, there is increasing experimental and clinical evidence that
polyvinylidene fluoride is superior to the widely used polypropylene, as outlined in the “prevention”
section. Furthermore, only covered polypropylene-based meshes may be used intraperitoneally. Up to now,
there is no available data on what happens with the covered meshes overlying each other, which is necessary
when using the sandwich technique. Also, the funnel-like 3-dimensional mesh is made by polyvinylidene
®
®
fluoride and is only available as Dynamesh IPST or Dynamesh IPST R. Therefore, the most effective
approaches of the prevention and treatment of parastomal hernias, which are intraperitoneal mesh-based
procedures, can only be done using meshes made by polyvinylidene fluoride.

CONCLUSION
The parastomal hernia significantly impairs the quality of life of patients. Therefore, preventive measures
are necessary. Inconsistent results of available studies can be explained by methodological and technical
aspects. Assuming adequate study design, an eventual parastomal hernia should be diagnosed clinically and
by CT. A long-term follow-up is needed, and, most important, the keyhole technique must be analyzed
separately from the intraperitoneal chimney technique using 3-dimensional implants with a funnel
surrounding the stoma-related bowel. The implantation technique must be strictly standardized. The same
facts are true for the repair of parastomal hernia. The clinical results are far from satisfying, and a lot of