title: How I do it: novel parastomal herniorrhaphy utilizing transversus abdominis release.
abstract: Parastomal hernias are a complex surgical problem affecting a large number of patients. Recurrences continue to occur despite various methods of repair. We present a novel method of open parastomal hernia repair with retromuscular mesh reinforcement in a modified Sugarbaker configuration.
  
  
  
  A full mildline laparotomy is performed and all adhesions are taken down. We then perform an open parastomal hernia repair by utilizing retromuscular dissection, posterior component separation via transversus abdominis release, and lateralization of the bowel utilizing a modified Sugarbaker mesh configuration within the retromuscular space. We demonstrate this technique in a cadaveric model for illustrative purposes.
  
  
  
  This repair provides the benefits of an open posterior component separation with transversus abdominis release and maintains the biomechanics of a functional abdominal wall, all while simultaneously benefitting from the advantages of mesh reinforcement in a modified Sugarbaker configuration. Our clinical experience with this novel technique to this point has been positive.
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. epauli@hmc.psu.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Pauli
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Juza
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Winder
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D034861:Abdominal Wall / Q000601:surgery; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*
keywords: Hernia; Herniorrhaphy; Mesh; Parastomal; Sugarbaker; Transversus abdominis