To compare the clinical efficacy of the Da Vinci robotic system and laparoscopic Sugarbaker repair for parastomal hernia, and to analyze the differences in effectiveness and underlying causes between the two surgical techniques.

A retrospective case-control study was conducted by analyzing the clinical data of patients who underwent Sugarbaker repair for parastomal hernia in the Department of Hernia and Abdominal Wall Surgery at Tianjin People’s Hospital between February 2023 and February 2025. A total of 56 patients were enrolled and divided into two groups according to the surgical approach: the robotic group (15 cases) and the laparoscopic group (41 cases). The two groups were compared in terms of preoperative body mass index (BMI), long diameter of the hernia ring, operative time, intraoperative blood loss, numerical rating scale (NRS) pain score on the first postoperative day, time to first flatus and defecation, postoperative hospital stay, and total hospitalization cost. Postoperative follow-up was performed to observe the recurrence of parastomal hernia and the occurrence of intestinal obstruction.

T There were no statistically significant differences between the two groups in preoperative BMI or hernia ring diameter. All operations were completed as planned without conversion to open surgery, change of surgical procedure, or occurrence of severe surgery-related complications. Compared with the laparoscopic group, the robotic group had a longer median operative time [M (IQR): 170 (60) min vs 105 (53) min] and higher median total hospitalization cost [70 562 (3 547) CNY vs 60 121 (12 341) CNY], but a shorter median postoperative hospital stay [4 (1) days vs 5 (2) days], shorter median time to defecation [3 (2) days vs 4 (1) days], and lower median NRS pain score on the first postoperative day [2 (1) points vs 5 (2) points]; all differences were statistically significant (P<0.05). The postoperative follow-up duration ranged from 1 to 24 months, with a median of 12 months. There were no significant differences between the two groups in the recurrence rate of parastomal hernia or the incidence of intestinal obstruction (P>0.05).

Both robotic and laparoscopic Sugarbaker repair for parastomal hernia are safe and feasible. The Da Vinci robotic approach offers advantages in reducing postoperative pain and facilitating rapid postoperative recovery, whereas laparoscopy demonstrates advantages in operative time and overall hospitalization cost.