To characterize the relationship between surgeon-staff familiarity and the time required to perform an operation. The clinical and operational efficiency of operating rooms (ORs) is a driver of hospital finances and patient outcomes. Surgeon-staff familiarity is an important focus for quality improvement and process optimization. A retrospective cohort study was performed analyzing operations performed at four academic hospitals between July 1,2019, and December 31,2023. Exclusion criteria (urgent operations, two-specialty cases, low surgeon/specialty volume in dataset, scheduled length > 8 hours) were applied to limit heterogeneity. The exposure of interest was familiarity between surgeon and allied health staff (scrub technicians and circulating nurses) present during an operation (represented as the median staff experience with the index surgeon in the previous 180 days). The primary outcome was whether the actual case length was (versus was not) 10% shorter than the scheduled case length ("shorter case length"). A secondary outcome was quantification of the difference between the observed and expected case length and whether the surgical time (cut-close) was shorter. A total of 257,645 operations performed by 25 different specialties comprised the analyzed cohort. Higher levels of surgeon-staff familiarity were associated with a higher likelihood of a shorter case length (observed:expected ratio = 1.16 [1.14-1.18] for high/high levels of familiarity, compared with 0.90 [0.88-0.91] for low/low levels of familiarity). Greater familiarity was also associated with case lengths that were shorter relative to scheduled case length (high/high levels of familiarity 8.7% shorter than low/low levels, P < 0.001). Within the four most common types of cases, those operations performed by teams with higher levels of familiarity had shorter surgical times (cut-to-close). This study found that operations were more efficiently performed when the scrub technician and circulating nurse staff had a greater recent experience with the primary surgeon. Surgical team familiarity should be considered a focus of operational and clinical excellence.

INTRODUCTION:Parastomal hernias (PSH) are a frequent complication following ostomy surgery, often requiring surgical intervention. Robotic surgery offers potential advantages in PSH repair, but evidence on its efficacy remains limited. This systematic review evaluates the outcomes of different robotic PSH repair techniques. EVIDENCE ACQUISITION:A systematic search of PubMed, Embase, and Cochrane databases was conducted (2015-2024) to identify studies on robotic PSH repair. Fourteen studies (13 retrospective, two prospective) met the inclusion criteria after screening 324 articles. EVIDENCE SYNTHESIS:Data on patient demographics, surgical techniques, complications, recurrence rates, and follow-up duration were extracted. The analysis included 355 patients with a median follow-up of 12 months. Early studies focused on feasibility and safety, with subsequent research refining specific techniques like the Sugarbaker, Pauli, and keyhole repairs. Reported recurrence rates ranged from 0% to 9.5% across these techniques. However, 30-day complication rates varied significantly (0% to 50%), highlighting the need for standardized reporting and patient selection criteria. While some studies demonstrated low recurrence rates with acceptable complication profiles, others revealed higher complication rates, potentially related to specific techniques or patient factors. The emergence of variations within the Sugarbaker technique, such as the retromuscular approach with transversus abdominis release (TAR), demonstrates ongoing innovation in robotic PSH repair. CONCLUSIONS:Robotic PSH repair shows promise, but further research is needed to confirm its long-term efficacy and cost-effectiveness.

BACKGROUND: Ileal pouch-anal anastomosis has become the gold standard for treating ulcerative colitis, familial adenomatous polyposis, and selected cases of Crohn’s colitis. Robotic surgery promises improved postoperative outcomes and decreased length of stay. However, few studies have evaluated the benefits of robotic ileal pouch-anal anastomosis compared to laparoscopy. OBJECTIVE: To compare short-term 30-day postoperative outcomes of robotic versus laparoscopic proctectomy with ileal pouch-anal anastomosis and diverting loop ileostomy. DESIGN: Retrospective observational study from a single, high-volume center . SETTINGS: Mayo Clinic, Rochester, MN (tertiary referral center for inflammatory bowel disease). PATIENTS: All adult patients undergoing minimally invasive proctectomy with ileal pouch-anal anastomosis and DLI between January 2015 and April 2023. MAIN OUTCOME MEASURES: Thirty-day complications, hospital length of stay, estimated blood loss, conversion rate, 30-day readmission, and 30-day reoperation. RESULTS: Two hundred seventeen patients were included in the study; 107 underwent robotic proctectomy with ileal pouch-anal anastomosis and diverting loop ileostomy, while 110 had laparoscopic proctectomy with ileal pouch-anal anastomosis and diverting loop ileostomy. Operating time was significantly longer in the robotic group (263 ± 38 minutes versus 228 ± 75 minutes, p < 0.0001); estimated blood loss was lower in the robotic group (81.5 ± 77.7 ml vs. 126.8 ± 111.0 ml, p = 0.0006) as well as the number of conversions (0% versus 8.2%, p = 0.003). Patients in the robotic group received more intraoperative fluids (3099 ± 1140 ml versus 2472 ± 996 ml, p = 0.0001). However, there was no difference in length of stay, 30-day morbidity, 30-day readmission, 30-day reoperation, rate of diverting loop ileostomy closure at three months, and surgical ileal pouch-anal anastomosis complication rate after ileostomy closure. LIMITATIONS: Retrospective design, single-center study, potential bias due to the novelty of robotic approach, lack of long-term and quality-of-life outcomes. CONCLUSIONS: Robotic proctectomy with ileal pouch-anal anastomosis and diverting loop ileostomy may offer advantages in terms of estimated blood loss and conversion rate, while maintaining the benefits of minimally invasive surgery. Further research is needed to evaluate long-term outcomes. See Video Abstract .

IntroductionPatients with inflammatory bowel disease are reported to be at elevated risk for postoperative venous thromboembolism (VTE). The rate and location of these VTE complications is unclear.MethodsPatients with ulcerative colitis (UC) or Crohn’s disease (CD) undergoing intestinal operations between January 2006 and March 2021 were identified from the medical record at a single institution. The overall incidence of VTEs and their anatomic location were determined to 90 days postoperatively.ResultsIn 2716 operations in patients with UC, VTE prevalence was 1.95% at 1-30 days, 0.74% at 31-60 days, and 0.48% at 90 days (P < 0.0001). Seventy two percent of VTEs within the first 30 days were in the portomesenteric system, and this remained the location for the majority of VTE events at 31-60 and 61-90 days postoperatively. In the first 30 days, proctectomies had the highest incidence of VTEs (2.5%) in patients with UC. In 2921 operations in patients with CD, VTE prevalence was 1.43%, 0.55%, and 0.41% at 1-30 days, 31-60 days, and 61-90 days, respectively (P < 0.0001). Portomesenteric VTEs accounted for 31% of all VTEs within 30 days postoperatively. In the first 30 days, total abdominal colectomies had the highest incidence of VTEs (2.5%) in patients with CD.ConclusionsThe majority of VTEs within 90 days of surgery for UC and Crohn’s are diagnosed within the first 30 days. The risk of a VTE varies by the extent of the operation performed, with portomesenteric VTE representing a substantial proportion of events.

BACKGROUND: IPAA has become the criterion standard for treating ulcerative colitis, familial adenomatous polyposis, and selected cases of Crohn's colitis. Robotic surgery promises improved postoperative outcomes and decreased length of stay. However, few studies have evaluated the benefits of robotic IPAA compared to laparoscopy. OBJECTIVE: To compare short-term 30-day postoperative outcomes of robotic versus laparoscopic proctectomy with IPAA and diverting loop ileostomy. DESIGN: Retrospective observational study from a single, high-volume center. SETTINGS: Mayo Clinic, Rochester, Minnesota (tertiary referral center for IBD). PATIENTS: All adult patients undergoing minimally invasive proctectomy with IPAA and diverting loop ileostomy between January 2015 and April 2023. MAIN OUTCOME MEASURES: Thirty-day complications, hospital length of stay, estimated blood loss, conversion rate, 30-day readmission, and 30-day reoperation. RESULTS: Two hundred seventeen patients were included in the study; 107 underwent robotic proctectomy with IPAA and diverting loop ileostomy, whereas 110 had laparoscopic proctectomy with IPAA and diverting loop ileostomy. Operating time was significantly longer in the robotic group (263 +/- 38 vs 228 +/- 75 minutes, p < 0.0001). The robotic group also had lower estimated blood loss (81.5 +/- 77.7 vs 126.8 +/- 111.0 mL, p = 0.0006) as well as fewer conversions (0% vs 8.2%, p = 0.003). Patients in the robotic group received more intraoperative fluids (3099 +/- 1140 vs 2472 +/- 996 mL, p = 0.0001). However, there was no difference in length of stay, 30-day morbidity, 30-day readmission, 30-day reoperation, rate of diverting loop ileostomy closure at 3 months, and surgical IPAA complication rate after ileostomy closure. LIMITATIONS: Retrospective design, single-center study, potential bias because of the novelty of the robotic approach, and lack of long-term and quality-of-life outcomes. CONCLUSIONS: Robotic proctectomy with IPAA and diverting loop ileostomy may offer advantages in terms of estimated blood loss and conversion rate while maintaining the benefits of minimally invasive surgery. Further research is needed to evaluate long-term outcomes. See Video Abstract.

INTRODUCTION:The purpose of this study was to evaluate the association of MIS approaches for rectal cancer with long-term postoperative bowel dysfunction. MATERIALS AND METHODS:This was an Institutional Review Board-approved observational cohort study including consecutive patients with rectal or rectosigmoid cancer who underwent surgical resection between 2007 and 2017. The primary exposure was surgical approach, defined as open surgery or MIS (laparoscopy or robotic surgery). The primary outcome was major LARS, defined as a LARS score of ≥30. Subgroup analyses were performed by tumor height and type of MIS approach. RESULTS:Among 749 potentially eligible patients, 514 (68.6 %) responded to the survey and were included for analysis. In total, 195 (37.9 %) patients underwent an MIS approach - 117 (60.0 %) laparoscopic and 78 (40.0 %) robotic. At a median follow-up of 6.1 (3.7-9.6) years from surgery, 222 patients (43.2 %) had major LARS (MIS: 41.0 % vs. open: 44.5 %, p = 0.44). On multivariable logistic regression, surgical approach had no association with major LARS (MIS, aOR: 1.21, 0.79-1.86). Older age (aOR: 1.03, 1.01-1.04), female sex (aOR: 1.75, 1.16-2.67), TME (aOR: 1.74, 1.01-3.02), diverting ileostomy (aOR: 2.74, 1.49-5.02) and radiation therapy (aOR: 2.63, 1.60-4.33) were all associated with major LARS. On subgroup analysis of patients with mid and low rectal cancers (n = 197), there remained no association between surgical approach and major LARS (MIS, aOR: 1.50, 0.68-3.33). CONCLUSIONS:MIS approach to rectal cancer surgery was not associated with decreased risk of major LARS and should not be touted as a reason to offer MIS.

BACKGROUND:Perianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas. METHODS:We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD. RESULTS:A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife-cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral. CONCLUSIONS:The results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome.

Parastomal hernia is a common occurrence following stoma construction, necessitating surgical intervention in symptomatic cases. This study presents a comprehensive analysis of Robotic-Assisted Parastomal Hernia Repair (r-PSHR), utilizing the Da Vinci Xi (TM) Surgical System. Retrospective analysis was conducted on patients undergoing r-PSHR at a high-volume center. Surgical variables, complications, and recurrence rates were assessed. The primary technique involved a modified Sugarbaker intraperitoneal onlay mesh. Eighty-six patients underwent r-PSHR, predominantly females (59.3%), with mean age 60.8 years. Mean BMI was 31.0. Most patients were classified as ASA 2 (31.4%) or ASA 3 (65.1), with 64.6% having no prior PSH repair. Index procedures primarily involved laparoscopic colonic resections (27.8%) and open abdominoperineal resections (27.8%). Parastomal hernias were mainly associated with end ileostomy (50%) and end colostomy (47.7%). A hybrid modification was required in 22.1% of cases, with only one conversion to open repair. Mean operative time was 257 min. Thirty-day morbidity was 40.7% and includes ileus (24.4%), deep surgical-site infections (7.0%), acute kidney injury (5.8%), and sepsis (5.8%). Grade IIIB complications occurred in 5.8% of cases. Thirty-day readmissions were observed in 19.8% of cases. There were five cases (5.8%) of recurrence within 15 months post-surgery. This study highlights the effectiveness of r-PSHR in managing parastomal hernia. R-PSHR shows promising outcomes with an acceptable post-operative occurrence profile and a favorable recurrence rate.

BACKGROUND:Although laparoscopic Ileal pouch-anal anastomosis (IPAA) has become the gold standard in restorative proctocolectomy, surgical techniques have experienced minimal changes. In contrast, substantial shifts in perioperative care, marked by the enhanced recovery program (ERP), modifications in steroid use, and a shift to a 3-staged approach, have taken center stage. METHODS:Data extracted from our prospective IPAA database focused on the first 100 laparoscopic IPAA cases (historic group) and the latest 100 cases (modern group), aiming to measure the effect of these evolutions on postoperative outcomes. RESULTS:The historic IPAA group had more 2-staged procedures (92% proctocolectomy), whereas the modern group had a higher number of 3-staged procedures (86% proctectomy) (P < .001). Compared with patients in the modern group, patients in the historic group were more likely to be on steroids (5% vs 67%, respectively; P < .001) or immunomodulators (0% vs 31%, respectively; P < .001) at surgery. Compared with the historic group, the modern group had a shorter operative time (335.5 ± 78.4 vs 233.8 ± 81.6, respectively; P < .001) and length of stay (LOS; 5.4 ± 3.1 vs 4.2 ± 1.6 days, respectively; P < .001). Compared with the modern group, the historic group exhibited a higher 30-day morbidity rate (20% vs 33%, respectively; P = .04) and an elevated 30-day readmission rate (9% vs 21%, respectively; P = .02). Preoperative steroids use increased complications (odds ratio [OR], 3.4; P = .01), whereas 3-staged IPAA reduced complications (OR, 0.3; P = .03). ERP was identified as a factor that predicted shorter stays. CONCLUSION:Although ERP effectively reduced the LOS in IPAA surgery, it failed to reduce complications. Conversely, adopting a 3-staged IPAA approach proved beneficial in reducing morbidity, whereas preoperative steroid use increased complications.

Parastomal hernia (PSH) is a prevalent long-term morbidity associated with stoma construction, and the optimal operative management remains uncertain. This study addresses the need for a standardized approach to symptomatic PSH repair, focusing on the robotic-assisted modified Sugarbaker technique with composite permanent mesh. The study, conducted in a high-volume colon and rectal surgery referral practice, outlines a systematic approach to patient selection, surgical procedures, and postoperative care. Preoperative evaluations include detailed medical and surgical histories, impact assessments of PSH, and oncological history reviews. The surgical technique involves the Da Vinci Xi™ robotic platform for adhesiolysis, hernia content reduction, stoma revision if needed, narrowing of the enlarged stoma trephine, lateralization of the stoma limb of bowel, and securing the mesh to the abdominal wall. Outcomes are reported for 102 patients undergoing robotic parastomal hernia repair from January 2021 to July 2023. Conversion to open surgery occurred in only one case (0.9

Background: Surgical site infections (SSIs) are one of the most common complications following diverting loop ileostomy (DLI) closures. This study assesses SSIs after DLI closure and the temporal trends in skin closure technique. Methods: A retrospective review was conducted using the American College of Surgeons National Surgical Quality Improvement Program database for adult patients who underwent a DLI closure between 2012 and 2021 across a multistate health system. Skin closure technique was categorized as primary, primary + drain, or purse-string closure. The primary outcome was SSI at the former DLI site. Results: A SSI was diagnosed in 5.7% of patients; 6.9% for primary closure, 5.7% for primary closure + drain, and 2.7% for purse-string closure (p 1/4 0.25). A diagnosis of Crohn's disease, diverticular disease, and increasing operative time were significant risk factors for SSIs. There was a positive trend in the use of purse-string closure over time (p < 0.0001). Conclusions: This study identified a low SSI rate after DLI closure which did not vary significantly based on skin closure technique. Utilization of purse-string closure increased over time.

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BACKGROUND:Existing venous thromboembolism (VTE) risk scores help identify patients at increased risk of postoperative VTE who warrant extended prophylaxis in the first 30 days. However, these methods do not address factors unique to colorectal surgery, wherein the tumor location and operation performed vary widely. VTE risk may extend past 30 days. Therefore, we aimed to determine the roles of tumor location and operation in VTE development and evaluate VTE incidence through 90 days postoperatively.STUDY DESIGN:Adult patients undergoing surgery for colorectal cancer between January 1, 2005, and December 31, 2021, at a single institution were identified. Patients were then stratified by cancer location and by operative extent. VTEs were identified using diagnosis codes in the electronic medical record and consisted of extremity deep venous thromboses, portomesenteric venous thromboses, and pulmonary emboli.RESULTS:A total of 6,844 operations were identified (72% segmental colectomy, 22% proctectomy, 6% total (procto)colectomy), and tumor location was most commonly in the ascending colon (32%), followed by the rectum (31%), with other locations less common (sigmoid 16%, rectosigmoid junction 9%, transverse colon 7%, descending colon 5%). The cumulative incidence of any VTE was 3.1% at 90 days with a relatively steady increase across the entire 90-day interval. Extremity deep venous thromboses were the most common VTE type, accounting for 37% of events, and pulmonary emboli and portomesenteric venous thromboses made up 33% and 30% of events, respectively. More distal tumor locations and more anatomically extensive operations had higher VTE rates.CONCLUSIONS:When considering extended VTE prophylaxis after colorectal surgery, clinicians should account for the operation performed and the location of the tumor. Further study is necessary to determine the optimal length of VTE prophylaxis in high-risk individuals.

Background: Literature evaluating intraoperative temperature/humidity and risk of surgical site infection (SSI) is lacking. Methods: All operations at three centers reported to the ACS-NSQIP were reviewed (2016-2020); ambient intraoperative temperature (degrees F) and relative humidity (RH) were recorded in 15-min intervals. The primary endpoint was superficial SSI, which was evaluated with multi-level logistic regression. Results: 14,519 operations were analyzed with 179 SSIs (1.2%). The lower/upper 10th percentiles for temperature and RH were 64.4/71.4 degrees F and 33.5/55.5% respectively. Low or high temperature carried no significant increased risk for SSI (Low degrees F OR = 0.95, 95% CI 0.51-1.77, P = 0.86; High degrees F OR = 1.13, 95% CI = 0.69-1.86, P = 0.63). This was also true for low and high RH (Low RH OR = 0.96, 95% CI 0.58-1.61, p = 0.88; High RH OR = 0.61, 95% CI = 0.33-1.14, P = 0.12). Analysis of combined temperature/humidity showed no increased risk for SSI. Conclusion: Significant deviations in intraoperative temperature/humidity are not associated with increased risk of SSI. (c) 2023 Elsevier Inc. All rights reserved.

Background: Poor postoperative glycemic control has been linked with higher mortality, cardiovascular complications, stroke, infection, impaired wound healing, and increased length of stay. Methods: This multicenter, retrospective study of colorectal surgery patients with Type 2 Diabetes Mellitus evaluated the difference in mean blood glucose levels postoperatively in a pharmacist driven glycemic management model vs standard of care. Secondary objectives assessed hyperglycemic events, severe hyperglycemia, hypoglycemia, postoperative infection, and rates of endocrinology consults. Results: 186 patients were included, 120 in the pharmacist driven cohort and 66 in the standard of care. The pharmacist managed cohort demonstrated significantly lower mean blood glucose (133.9 vs 148.3 mg/dL, 95% CI [-17 to -11] p < 0.001), significantly fewer hyperglycemic events (9.6% vs 20.5%, p < 0.0001), and nonsignificant reduction of hypoglycemic events (0.7% vs 1.2%, p = 0.1443). Conclusions: Expansion of the postoperative care team by utilizing pharmacists to manage postoperative blood glucose resulted in improved glycemic control.

Colorectal DiseaseEarly View VIDEO CORRESPONDENCE Robotic-assisted parastomal hernia repair using the Sugarbaker technique Francisco J. Cardenas Lara, Francisco J. Cardenas Lara Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USASearch for more papers by this authorRobert R. Cima, Corresponding Author Robert R. Cima [email protected] Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA Correspondence Robert R. Cima, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA. Email: [email protected]Search for more papers by this author Francisco J. Cardenas Lara, Francisco J. Cardenas Lara Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USASearch for more papers by this authorRobert R. Cima, Corresponding Author Robert R. Cima [email protected] Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA Correspondence Robert R. Cima, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA. Email: [email protected]Search for more papers by this author First published: 23 October 2023 https://doi.org/10.1111/codi.16779 This work is intended to contribute to the Video Library of the Colorectal Disease Journal. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, et al. European hernia society guidelines on prevention and treatment of parastomal hernias. Hernia. 2018; 22(1): 183–198. 10.1007/s10029-017-1697-5 CASPubMedWeb of Science®Google Scholar 2Okorji LM, Kasten KR. Diagnosis and management of parastomal hernias. Dis Colon Rectum. 2019; 62(2): 158–162. 10.1097/DCR.0000000000001293 PubMedWeb of Science®Google Scholar 3Davis BR, Valente MA, Goldberg JE, Lightner AL, Feingold DL, Paquette IM, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for ostomy surgery. Dis Colon Rectum. 2022; 65(10): 1173–1190. 10.1097/DCR.0000000000002498 PubMedWeb of Science®Google Scholar 4Makarainen-Uhlback EJ, Klintrup KHB, Vierimaa MT, Carpelan-Holmstrom MA, Kossi JAO, Kairaluoma MV, et al. Prospective, randomized study on the use of prosthetic mesh to prevent a parastomal hernia in a permanent colostomy: results of a long-term follow-up. Dis Colon Rectum. 2020; 63(5): 678–684. 10.1097/DCR.0000000000001599 PubMedWeb of Science®Google Scholar 5Pauli EM, Juza RM, Winder JS. How I do it: novel parastomal herniorrhaphy utilizing transversus abdominis release. Hernia. 2016; 20(4): 547–552. 10.1007/s10029-016-1489-3 PubMedWeb of Science®Google Scholar 6Majumder A, Orenstein SB, Miller HJ, Novitsky YW. Stapled transabdominal ostomy reinforcement with retromuscular mesh (STORRM): technical details and early outcomes of a novel approach for retromuscular repair of parastomal hernias. Am J Surg. 2018; 215(1): 82–87. 10.1016/j.amjsurg.2017.07.030 PubMedWeb of Science®Google Scholar 7Ayuso SA, Shao JM, Deerenberg EB, Elhage SA, George MB, Heniford BT, et al. Robotic Sugarbaker parastomal hernia repair: technique and outcomes. Hernia. 2021; 25(3): 809–815. 10.1007/s10029-020-02328-x CASPubMedWeb of Science®Google Scholar 8Fleming AM, Phillips AL, Drake JA, Gross MG, Yakoub D, Monroe J, et al. Sugarbaker versus keyhole repair for parastomal hernia: a systematic review and meta-analysis of comparative studies. J Gastrointest Surg. 2023; 27(3): 573–584. 10.1007/s11605-022-05412-y PubMedWeb of Science®Google Scholar 9Gameza VA, Bell Lybecker M, Wara P. Laparoscopic keyhole versus Sugarbaker repair in parastomal hernia: a long-term case-controlled prospective study of consecutive patients. J Laparoendosc Adv Surg Tech A. 2020; 30(7): 783–789. 10.1089/lap.2020.0074 PubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation