A novel technique created for parastomal hernia repair from a hybridisation model of published evidence: The SSIMPLE approach

The treatment of parastomal hernias (PSH) represents a major challenge in hernia surgery. Various techniques have been reported with different outcomes in terms of complication and recurrence rates. Most of the techniques have certain advantages and disadvantages. The aim of this manuscript is to describe our novel approach to have created a new technique for repair of PSH associated with end stomas. This is an "existing orifice" least invasive surgery that combines the advantages of most of the recognised procedures while minimizing the drawbacks of each and at the same time making it reproducible in safe hands, using the DynaMesh- IPST 3D funnel mesh made of polyvinylidene fluoride (PVDF). With these points in mind, we present the SSIMPLE approach (Stomal access Sublay IPST Mesh repair of ParastomaL hErnia). This is a technique-oriented paper where we offer feasibility, proof of concept in 2 cases with images and illustrations prior to adopting this in a wider cohort. This includes one PSH associated with end ileostomy and one with end colostomy. This also utilises the sac of the parastomal hernia with no other incisions apart from the existing stoma orifice.