The first robotic STORRM: A case report

Abstract

Parastomal hernias present a continued challenge to the general surgeon. There are a myriad of techniques available, with hernia recurrence rates varying between 10 to greater than 50%. Mesh reinforcement and underlay or sublay placement are associated with lower hernia recurrence rates. Many patients with parastomal hernia have associated comorbidities which increase their risk for perioperative wound complications. Robotic and minimally invasive techniques offer decreased rate of wound complications, but can be challenging to perform if the stoma needs to be relocated. For patients with complex parastomal hernias requiring abdominal wall reconstruction with transversus abdominis release and retromuscular mesh placement, it can be difficult to align the layers of the abdominal wall and create an aperture in the mesh to allow for a straight passage of the conduit and prevent subsequent angulation of the bowel. Stapled Transabdominal Ostomy Reinforcement with retromuscular mesh, or STORRM technique, has been previously described elsewhere as a technique whereby a circular EEA (End-to-End Anastomoses) stapler is used to create a straight tunnel through the mesh and abdominal wall layers, standardize sizing, fixate the mesh, and substitute traditional cruciate incisions with a stapled reinforcement of the aperture in the mesh/tissues.