# The TRAPPIST Repair: A Novel TRAnsabdominal PrePeritoneal Intervention for ParaSTomal Hernias – Case Report With Video-Vignette

## TL;DR

A new robotic surgical technique called TRAPPIST is introduced for repairing parastomal hernias, offering potential benefits over existing methods.

## Contribution

The TRAPPIST repair is a novel robotic transabdominal preperitoneal technique for parastomal hernia repair.

## Key findings

- The TRAPPIST repair was successfully performed in a patient with no postoperative complications or recurrence at 2 months.
- The technique isolates the mesh from the abdominal cavity, potentially reducing mesh-related complications.
- The procedure requires experience and careful patient selection due to the complexity of peritoneal dissection.

## Abstract

Parastomal hernia (PSH) is a common complication following stoma formation, often requiring surgical repair. While techniques such as Sugarbaker and Pauli have improved outcomes, concerns persist regarding intraperitoneal mesh exposure and the disruption of the transversus abdominis muscle insertion during retromuscular repairs. We describe a novel robotic transabdominal preperitoneal Intervention for PSH repair (TRAPPIST), with mesh placement between the peritoneum and posterior rectus sheath, potentially offering anatomical and functional advantages.

We report the case of a male patient with symptomatic PSH after left-sided colostomy. Robotic repair was performed using a transabdominal preperitoneal approach. A wide peritoneal flap was created to access the preperitoneal space, followed by lateralization of the stoma, partial closure of the hernia defect, and placement of a lightweight large-pore mesh within the preperitoneal compartment. The mesh was secured with interrupted sutures, and the peritoneum was closed to isolate the prosthesis from the abdominal cavity.

The procedure was completed without complications. The postoperative course was uneventful, with discharge on day 4. At 2 months follow-up, no signs of recurrence, mesh-related complications, or stoma dysfunction were observed.

TRAPPIST repair is technically feasible and may reduce mesh-related complications by avoiding intraperitoneal exposure. However, due to the complexity of wide peritoneal dissection, this technique requires experience and careful patient selection. It can serve as a first-line option with the possibility of conversion to Sugarbaker or Pauli repair if needed. Further studies are warranted to assess long- term outcomes.