Laparoscopic parastomal hernia repair: keyhole, Sugarbaker, sandwich, or hybrid technique with 3D mesh? An updated systematic review and meta-analysis.

PURPOSE: Parastomal hernia is the most common complication after stoma formation with an incidence that approaches 50% at 2 years postoperatively. In the last decade, different approaches of minimally invasive procedures have been proposed for the treatment of parastomal hernia. Nevertheless, the superiority of one technique over the others remains still unclear. Our objective was to update and systematically analyze current state of research concerning the postoperative outcomes of the four most prevalent minimally invasive techniques. METHODS: A systematic literature search of three databases (Medline, Scopus, Google Scholar) was undertaken for articles published from January 2015 to November 2022. Fifteen studies from a previous meta-analysis on the topic were included. RESULTS: Thirty-three studies incorporating 1289 total patients were deemed eligible for inclusion in the final analysis. The keyhole technique was associated with the highest incidence of postoperative complications and recurrences (31.3% and 24.1%, respectively), followed by the Sugarbaker technique (27.6% and 9%, respectively). Operative time was among the lowest in patients operated with the 3D mesh technique, while patients undergoing the keyhole technique experienced the shortest cumulative length of hospital stay (6 days). CONCLUSION: Each technique demonstrates a unique profile of effectiveness offset by the propensity towards developing postoperative complications. While no conclusive evidence on the optimal technique exist to date, newer minimally invasive techniques show promising results, albeit based on limited data. The future of parastomal hernia repair seems to rely on a highly individualized approach, tailored to the distinctive characteristics of both the hernia and the patient.

Fournier's Gangrene Associated With Untreated Crohn's Disease in a Male Patient: A Case Report and Review of the Literature.

Crohn's disease is a chronic idiopathic inflammatory bowel disease that can affect any part of the gastrointestinal tract. Perianal symptoms are seen in one-third of Crohn's disease cases, with perianal abscesses leading to Fournier's gangrene being extremely rare. Herein, we discuss an interesting case of a male patient with Fournier's gangrene as a result of untreated Crohn's disease. A 51-year-old male presented to the emergency department with a perianal abscess and cellulitis of the perineum. Examination under general anesthesia (EUA) of the rectum and incision and drainage (I&D) of the abscess were performed urgently, leading to the diagnosis of Fournier's gangrene. Subsequent investigations revealed that the causative factor was a previously diagnosed but untreated Crohn's disease. The comprehensive treatment plan included fecal diversion, regular surgical debridement, negative pressure wound therapy, antibiotics administration, and perineal reconstruction. After a 37-day hospital stay, the patient was discharged in good clinical condition and referred to a specialized gastroenterologist for further treatment. A year later, he underwent an ileocecal resection with ileocolic anastomosis. In rare circumstances, Crohn's disease may manifest solely through perianal symptoms and, even more rarely, as Fournier's gangrene. It is crucial for clinicians to be aware of this manifestation for early diagnosis and prompt treatment. Maintaining a high level of suspicion, achieving early diagnosis, implementing prompt resuscitation, and adopting a multidisciplinary approach within specialized medical centers are crucial factors for effective management in these cases.