title: Single-port laparoscopic parastomal hernia repair with modified sugarbaker technique.
abstract: BACKGROUND
  Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery.
  
  
  METHODS
  All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, "inline" and "chopsticks" to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh.
  
  
  RESULTS
  Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m(2) did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm(2) with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months.
  
  
  CONCLUSIONS
  Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care.
authors.affiliation: Discipline of Surgery, Sydney Medical School, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; The Sydney Hernia Specialists Clinic, Level 2, 195 Macquarie St, Sydney NSW 2000, Australia. info@sydneyherniaspecialists.com.au.
authors.forename: Hanh
authors.initials: H
authors.lastname: Tran
authors.affiliation: The Sydney Hernia Specialists Clinic, Sydney, NSW, Australia.
authors.forename: Isidro
authors.initials: I
authors.lastname: Turingan
authors.affiliation: The Sydney Hernia Specialists Clinic, Sydney, NSW, Australia.
authors.forename: Marta
authors.initials: M
authors.lastname: Zajkowska
authors.affiliation: The Sydney Hernia Specialists Clinic, Sydney, NSW, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Tran
mesh_terms: D004766:Enterostomy / Q000009:adverse effects*; D004867:Equipment Design; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques