ABSTRACT
Objective: To compare laparoscopic Keyhole repair with the modified Sugarbaker repair in a nonrandomized case-controlled prospective study of consecutive patients with parastomal hernia. Background: Two reviews of uncontrolled studies concluded that the Sugarbaker repair is superior to the Keyhole repair. The present study challenges the claim. Materials and Methods: In two time periods, 135 patients with a parastomal hernia were repaired with the Keyhole technique (74 patients, using a two-layer mesh of polypropylene and polytetrafluoroethylene [ePTFE] with a self-cut slit, 1997-2009) or the Sugarbaker technique (61 patients, using a coated polypropylene mesh, 2009-2015). The patients in the two groups matched with regard to clinical profile, colostomy or ileostomy hernia, previous repairs, size of fascial defect, and simultaneous repair of a concurrent incisional hernia. Observation time was defined as time to recurrence, stoma resiting, mesh removal, death, or last nonevent visit. Results: In-hospital morbidity did not differ with two fatalities in each group. Seventy and fifty-eight patients after Keyhole and Sugarbaker repair, respectively, were available for follow-up. Two patients after Sugarbaker repair were lost to follow-up. After a median follow-up of 57 months, five recurrences were diagnosed in the Keyhole group (7%). In the Sugarbaker group, six recurrences (10%) were observed after a median follow-up of 11 months. Late mesh-related morbidity occurred in 6 and 6 patients after Keyhole (8%) and Sugarbaker repair (10%), respectively. Conclusion: The present study indicates that the Keyhole repair, using a polypropylene mesh with an antiadhesive layer, compares favorably with the Sugarbaker repair with regard to postoperative complications, recurrence rate, and late mesh-related morbidity. ClinicalTrials.gov Identifier: NCT00000418 7235.
