# Parastomal hernia repair using retromuscular 3D funnel mesh: the “Sugar Funnel” technique

## TL;DR

A new surgical technique using a 3D funnel mesh reduces parastomal hernia recurrence and addresses stoma bulge in patients.

## Contribution

A novel retromuscular 3D funnel mesh repair technique for parastomal hernias is introduced and evaluated.

## Key findings

- Fifteen patients had no hernia recurrence at median 15-month follow-up.
- The technique also addressed peristomal bulge in 87% of patients.
- Complications included wound infection, seroma, and stoma issues in a few cases.

## Abstract

Parastomal hernias are a common and complex problem for patients and their surgeons. Despite multiple established repair strategies, recurrence rates remain high. We present a novel open retromuscular repair technique using a 3D funnel mesh.

The technique involves retrorectus dissection, transversus abdominis release (TAR), lateralisation of the stomal conduit, and retromuscular placement of a 3D funnel mesh. A second flat mesh reinforces the remaining retromuscular space. Abdominoplasty was performed where excess skin or fat contributed to the parastomal ‘bulge’.

Fifteen patients underwent repair (median age 59 years, BMI 33.8 kg/m²). Nine had a colostomy and six an ileostomy. Five (33%) had a recurrent parastomal hernia, and 13 (87%) had concomitant incisional hernia. The median combined transverse defect width was 11.9 cm (IQR 10.4–12.2). Abdominoplasty was performed in 13 patients (87%). At median 15-month follow-up, no recurrences, stenoses, or obstructions were observed. Complications included wound infection (n = 2), seroma (n = 1), abscess (n = 1), stoma prolapse (n = 1), and stoma retraction (n = 1). Two patients required stoma refashioning.

The retromuscular 3D funnel mesh technique offers a robust repair with potential advantages over other recognized repair options. It also addresses the peristomal ‘bulge’ of redundant skin and excess subcutaneous fat that can compromise stoma appliance application and adherence. Comparative studies focused on patient reported outcome measures are needed to determine if this technique confers advantages over other established procedures.