Abstract:

Laparoscopic repair of parastomal hernia was initially performed with the Sugarbaker technique. Owing to potential complications such as bowel incarceration, the Keyhole technique was subsequently developed, followed by reports of the Sandwich technique and various hybrid approaches. In the early stage, the totally laparoscopic Keyhole technique was most widely applied; however, its limitations, particularly the high recurrence rate, became increasingly evident. Although the Sandwich technique demonstrated favorable efficacy, its application remained limited because of excessive prosthetic material. The laparoscopic redo of the stoma at the original site (Lap-re-Do), derived from hybrid technique and combined with the Keyhole technique, offered procedural optimization. During the intermediate stage, its technical workflow was progressively refined and widely adopted in clinical practice. Nevertheless, the inherent defect of the Keyhole technique, namely the mesh aperture, constrained further improvement in overall outcomes. In the mid-to-late stage, following “weak” recommendations in clinical guidelines, the Sugarbaker technique regained prominence, accompanied by the emergence of novel approaches such as minimally invasive extraperitoneal Sugarbaker repair. However, the fundamental concerns that initially limited the Sugarbaker technique persist. The application of Lap-re-Do declined due to the lack of synergistic optimization with the Sugarbaker technique and the potential risks of infection and stoma-related complications. Parastomal hernia repair is essentially a quality-of-life-oriented intervention. When overall efficacy is comparable, the simplest surgical approach should be preferred. At present, no gold-standard technique exists for parastomal hernia repair, and each minimally invasive method has distinct advantages and inherent limitations. Under routine circumstances, a totally laparoscopic Sugarbaker technique is recommended as the preferred option. For complex hernias with indications for stoma reconstruction, Lap-re-Do combined with either the Keyhole or Sugarbaker technique may be considered.

Key words: Parastomal hernia, Laparoscopy, Keyhole technique, Sugarbaker technique, Laparoscopic redo of the stoma at the original site （Lap-re-Do）, Hybrid technique