# Hybrid parastomal endoscopic repair (HyPER): a retrospective case series of 200 patients treated over ten years at a single center

## TL;DR

A new surgical technique called HyPER was developed and tested on 200 patients to treat parastomal hernias, showing safety and effectiveness with low recurrence rates.

## Contribution

The HyPER technique combines laparoscopic and open approaches to address parastomal hernias, offering a novel hybrid surgical method.

## Key findings

- The HyPER technique had a 5.5% recurrence rate and improved quality of life in patients.
- A cost-effective modification using polypropylene mesh was successfully applied in 10% of cases.
- Postoperative complications occurred in 12.5% of patients, primarily wound infections.

## Abstract

Parastomal hernia is a common and challenging complication after stoma formation, often requiring complex surgical management. To address limitations of conventional techniques, we developed the Hybrid Parastomal Endoscopic Repair (HyPER) technique, which combines laparoscopic and open approaches. This case series aimed to evaluate the long-term safety, efficacy, and technical considerations of the HyPER method in a large, consecutive cohort of patients.

This retrospective, single-center case series included 200 consecutive patients treated between 2014 and 2024. Adult patients with symptomatic or recurrent parastomal hernias were included; exclusion criteria were severe comorbidities precluding surgery or lack of follow-up data. Demographic and operative variables, perioperative outcomes, and recurrence rates were analyzed. Descriptive statistics were used (mean, SD, range); no hypothesis testing was applied.

The majority of patients had EHS Type III or IV hernias. The mean operative time was 171 min. In 10% of cases, a cost-effective “Baldachin modification” using polypropylene mesh was employed. Stoma relocation was required in 87% of Type IV cases. Postoperative complications occurred in 12.5%, primarily wound infections. The recurrence rate was 5.5%, and quality of life significantly improved (VAS score increased from 3.15 to 9.15). No mortality was observed.

HyPER proved to be a safe and effective technique for treating parastomal hernias, especially in complex and recurrent cases. The approach allowed for thorough anatomical correction and yielded low recurrence rates with acceptable morbidity. The Baldachin modification may offer a viable low-cost alternative in resource-limited settings. Further multicenter studies are warranted to validate these findings and establish standardized protocols.

The online version contains supplementary material available at 10.1007/s00464-025-12318-8.