Sugarbaker Transversus Abdominis Release Retrorectus Mesh Placement (STAR) Procedure for Large Parastomal Hernia with Loss of Domain

Abstract

Parastomal hernia is the most common long-term complication following the creation of a temporary or permanent stoma after colorectal surgery and can affect patients physically and emotionally, thereby altering quality of life. Symptomatic patients require surgical intervention, and various techniques have been described in the literature. The Sugarbaker, keyhole, and sandwich techniques are commonly performed. However, the presence of a large parastomal hernia with loss of domain poses a unique challenge. As with incisional hernias, transversus abdominis muscle release (TAR) facilitates tension-free closure of the abdomen. Hence, TAR can be combined with standard procedures for parastomal hernia repair for the optimal management of such hernias, and the addition of mesh to reinforce the closure may prevent recurrence. We present the case of a 48-year-old woman who had previously undergone abdominoperineal resection and developed a large parastomal hernia with loss of domain. She underwent a combination of the Sugarbaker technique, bilateral transversus abdominis release, and retrorectus mesh placement (Sugarbaker + Transversus Abdominis release + Retrorectus mesh placement = STAR procedure or Pauli’s modified repair of parastomal hernia), along with cholecystectomy. This case report describes the clinical details, surgical steps, and outcome of the “STAR” procedure.