title: Modified laparoscopic Sugarbaker repair decreases recurrence rates of parastomal hernia.
abstract: BACKGROUND
  Parastomal hernia (PH) is a frequent complication of stoma formation, and recurrence after repair is common. A laparoscopic modified Sugarbaker technique (SB) may decrease the recurrence of PH compared with other methods.
  
  
  METHODS
  A retrospective review, approved by the institutional review board, of patients who underwent PH repair between 2004 and 2014 was performed. Demographics, factors for ostomy formation, hernia risk factors, intraoperative and postoperative information, and recurrence data were compared among SB and other techniques. Time to recurrence was compared between SB versus other techniques with the Kaplan-Meier method and adjusted Cox proportional hazards regression modeling.
  
  
  RESULTS
  Sixty-two PH repairs were performed: 39 (61%) paraileostomy and 23 (39%) paracolostomy. Repairs included 25 laparoscopic modified SB and 37 from other techniques. There was no difference in demographics. Postoperative complication rate was lesser in SB versus all other groups (40% vs 76%, P = .02). Recurrence rates were lesser for SB versus all others (16% vs 60%, P < .001). Follow-up was similar among all groups. After adjustment, SB was found to be protective of recurrences (hazard ratio = .28, 95% confidence interval = 0.09-0.82).
  
  
  CONCLUSIONS
  A laparoscopic modified SB technique provides decreased rates of recurrence and postoperative complications compared with other approaches.
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: DeAsis
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: John G
authors.initials: JG
authors.lastname: Linn
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: Woody
authors.initials: W
authors.lastname: Denham
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
authors.forename: JoAnn M
authors.initials: JM
authors.lastname: Carbray
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL. Electronic address: mujiki@northshore.org.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ujiki
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D054047:Surgical Stomas; D013997:Time Factors; D016896:Treatment Outcome