The Edinburgh approach to the Pauli technique for isolated parastomal hernias without midline component
Darja Clinch, Voula Granitsiotis, Alexis Theodorou, Eric Pauli, Dimitrios DamaskosAbstract
Introduction
Parastomal hernia (PSH) is a common complication of stoma formation, and there is no consensus on the optimal surgical treatment of this challenging condition. In this technical note, our aim is to describe a novel approach by carrying out a Pauli repair through the stoma, thereby avoiding a midline laparotomy, and to evaluate its outcomes in a case series.
Methods
We provide a description and video of the technical steps of this novel approach. In addition, we carried out a retrospective single‐centre case series of six consecutive elective patients treated with this technique for PSH without a midline component and their immediate procedural outcomes (recurrence and complications).
Results
Six patients with a mean age of 56.8 years (range 39–72 years) and a mean BMI of 30.3 kg/m 2 underwent this modified Pauli repair between 2023 and 2025. Three patients (50%) had European Hernia Society (EHS) type III hernias. Median length of stay was 3.5 days (IQR 3–4.75). There were no Clavien Dindo ≥4 complications but a high rate (50%) of wound complications. We observed no clinical recurrences at a median follow‐up time of 13.6 months (IQR 7.9–20.2 months).
Discussion
Our modification of the Pauli technique for hernias without a midline component is feasible with promising short‐term results in patients with an ileal conduit. Further evaluation in larger cohorts with longer follow‐up is required to establish the safety and durability of this approach.
Originality Statement
This paper describes the feasibility of carrying out a Pauli repair of parastomal hernia via a local approach through the stoma, thereby avoiding the morbidity of a laparotomy in patients without a midline component. Further evaluation in larger cohorts with longer follow‐up is required to establish the safety and durability of this approach.