Parastomal hernia in the difficult patient: is Tophat plasty the solution?

PURPOSE: The aim of the study was to evaluate the safety, feasibility and short- and long - term outcomes following the Tophat plasty - a complete extra-abdominal procedure - for parastomal hernia. METHODS: A prospective observational single-center study including all patients operated with Tophat plasty at a regional tertiary referral university hospital in the period 2020-2024. RESULTS: Twenty- three patients were treated with the Tophat plasty. All procedures were performed by two surgeons. The median age was 70 years. Fifteen of the patients were males. Twelve patients had an ileal conduit, 7 had a colostomy and 4 had an ileostomy. The most common indication for surgery was obstruction, and three patients were operated in an acute setting. Medium operating time was 213 minutes. Two patients had recurrence after previous surgery for parastomal hernia. Three had concomitant incisional hernias. Ten patients had complications of which were registered according to the Clavien-Dindo classification. The median hospital stay was 6 days, and median follow-up was 34 months. Three (13%) recurrences were identified, of which two (9%) needed intervention. CONCLUSION: The Tophat plasty is an effective method for the treatment of parastomal hernias in cases where lateralization of the stoma is not feasible, intra-abdominal mesh placement has to be avoided, or when access to the abdominal cavity is challenging.