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Abdelsamad A, Mohammed MK, Almoshantaf MB, Alrawi A, Fadl ZA, Tarek Z, Aboelmajd NO, Herzog T, Gebauer F, Abdelsattar NK, Taha TAEA. Parastomal Hernia: direct repair versus relocation: is stoma relocation worth the risk? A comparative meta-analysis and systematic review. Updates Surg 2025:10.1007/s13304-025-02155-8. [PMID: 40163250 DOI: 10.1007/s13304-025-02155-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 02/26/2025] [Indexed: 04/02/2025]
Abstract
Parastomal hernia is a prevalent and challenging complication in patients with stomas, frequently necessitating surgical intervention. The two primary approaches to parastomal hernia repair- direct repair without relocation and stoma relocation- offer distinct benefits and drawbacks. This systematic review and meta-analysis aimed to compare the efficacy and safety of stoma relocation versus direct repair in managing parastomal hernia. Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies involving adult patients (≥ 18 years) with parastomal hernia who underwent either stoma relocation or direct repair, with a focus on clinically relevant outcomes. A comprehensive search of Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted up to September 2024. Key short-term outcomes (operative time, surgical site infection, urinary tract infection, bowel obstruction, length of hospital stay, and overall complications) and long-term outcomes (re-admission, recurrence, re-operation, and mortality) were extracted. Statistical analysis included risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Six studies were included, encompassing both laparoscopic and open-surgical techniques. Direct repair was associated with a significantly shorter operative time (MD: 115 min, 95% CI: 95.71 to 134, P < 0.00001) and a reduced length of hospital stay (MD: 2 days, 95% CI: 0.40 to 3.9, P = 0.02). While reoperation rates were significantly lower in the relocation group (RR: 0.15, 95% CI: 0.03 to 0.62, P = 0.009), other outcomes-including recurrence, re-admission, and overall complication rates-showed comparable results between the two approaches. Notably, there were no significant differences in surgical site infection, urinary tract infection, bowel obstruction, or mortality rates. Direct repair may be advantageous for reducing operative time and hospital stay, whereas stoma relocation appears beneficial in reducing reoperation rates. Future research should focus on developing standardized techniques and incorporating patient-specific factors to inform optimal surgical decision-making in parastomal hernia repair.
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Affiliation(s)
- Ahmed Abdelsamad
- Department of Surgery II, University of Witten-Herdecke, 58455, Witten, Germany.
- Oncological Surgery Department, Section Head of Robotic Surgery, Knappschaft Vest Hospital, 45657, Recklinghausen, Germany.
| | | | | | - Aya Alrawi
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ziad A Fadl
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ziad Tarek
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | - Torsten Herzog
- Department of Surgery II, University of Witten-Herdecke, 58455, Witten, Germany
- Department of Surgery, Bochum University, Bochum, Germany
| | - Florian Gebauer
- Oncological Surgery Department, Section Head of Robotic Surgery, Knappschaft Vest Hospital, 45657, Recklinghausen, Germany
- Head of Surgery Department, Helios University Hospital, Wuppertal, Germany
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Holland AM, Lorenz WR, Mead BS, Scarola GT, Augenstein VA, Heniford BT, Polcz ME. Long-term outcomes after open parastomal hernia repair at a high-volume center. Surg Endosc 2025; 39:639-648. [PMID: 39528661 DOI: 10.1007/s00464-024-11375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 10/20/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Open parastomal hernia repairs (OPHR) are complex with high recurrence rates and no clear optimal technique. This report summarizes long-term OPHR outcomes at a high-volume hernia center. METHODS OPHRs were identified from a prospectively maintained institutional database. Recurrence and wound complication rates were compared across operative techniques using standard statistical analysis. RESULTS Of 97 OPHR patients, mean age was 61.9 ± 12.6 years, 56.7% were female, 24.7% were diabetic, and average BMI was 31.3 ± 6.5 kg/m2. Mean defect size was 125.3 ± 130.0cm2 and 41.2% were recurrent. Stomas included colostomies (56.7%), ileostomies (30.9%), and urostomies (12.4%). Patients underwent concurrent ventral hernia repair (56.7%), panniculectomy (22.7%), and component separation (30.9%). Patients either had their stoma reversed (13.4%), resited (25.8%), or repaired in situ (60.8%) with suture (11.9%) or mesh (88.1%) in a Sugarbaker (65.4%), keyhole (19.2%), or onlay (15.4%) configuration. Over a mean follow-up of 31.6 ± 35.9 months, wound complications occurred in 18.6% and recurrences in 20.6%. There were no significant differences in recurrence by ostomy type. Recurrence rates were highest after in situ suture repair (42.9%), followed by resiting with mesh (34.8%), in situ with mesh (17.3%), and reversal (0.0%)(p = 0.042). When stomas were resited, prophylactic mesh compared to no mesh did not significantly impact recurrence (28.6%vs.50.0%;p = 0.570). Recurrence rates for in situ repairs were not statistically different by mesh technique (onlay 25.0%, Sugarbaker 17.7%, keyhole 10.0%;p = 0.751), but differed by location(retrorectus 50.0%, intraperitoneal 36.4%, onlay 25.0%, preperitoneal 6.5%;p = 0.035). Multivariable analysis did not demonstrate any independent predictors of recurrence or wound complications. CONCLUSION This study represents the largest series to date describing long-term OPHR outcomes with a variety of techniques. Recurrence was greatest after in situ primary repair. There were no recurrences after stoma reversal. After ostomy resiting, all recurrences occurred at the new stoma site, independent of prophylactic mesh use. When the stoma was repaired in situ, preperitoneal mesh placement had the lowest recurrence. Optimal technique for OPHR remains unclear, but these results may inform preoperative discussions and surgical planning.
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Affiliation(s)
- Alexis M Holland
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - William R Lorenz
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Brittany S Mead
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Gregory T Scarola
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Monica E Polcz
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
- Department of Surgery, Baptist Health South Florida, 8950 North Kendall Drive, Suite 601W, Miami, FL, 33176, USA.
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Roussel E, Dupuis H, Grosjean J, Cornu JN, Khalil H. Initial and recurrent management of parastomal hernia after cystectomy and ileal conduit urinary diversion: a 10 year single-center experience. Hernia 2024; 29:57. [PMID: 39738628 DOI: 10.1007/s10029-024-03207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/25/2024] [Indexed: 01/02/2025]
Abstract
PURPOSE The management of parastomal hernia following cystectomy and ileal conduit diversion is challenging due to its specific nature and a high recurrence rate, yet is poorly described. METHODS We retrospectively searched the clinical data warehouse of our center for patients who had primary parastomal hernia repair following cystectomy and ileal conduit diversion. The primary endpoint was recurrence of parastomal hernia; secondary endpoints were postoperative complications and surgical management of recurrences. RESULTS From January 1st 2012 to January 1st 2022, 35 patients were included in the study, 13 patients (37.1%) were operated with the Keyhole technique and 22 patients (62.9%) with the Sugarbaker technique. The median follow-up was 24 months. The main complication was urinary tract infection, in 6 patients (17.4%). Postoperative complications were severe in 4 patients (11.4%), 3 (8.6%) for prosthesis extraction due to infection. Ninety-day mortality was null. Eight patients (22.9%) had a symptomatic recurrence of parastomal hernia leading to a second surgery, 4 patients (30.7%) in the Keyhole group and 4 patients (18.2%) in the Sugarbaker group. Surgical management of recurrences involved repair without synthetic mesh in 4 patients (50%) due to difficult adhesiolysis, leading to a third surgery for 3 patients (37.5%). CONCLUSION The high rates of recurrence observed with the Keyhole technique, in particular, but also with the Sugarbaker technique, suggest that these techniques should no longer be used for the repair of parastomal hernia after ileal conduit urinary diversion. New preventive and curative approaches need to be explored to improve the surgical management of parastomal hernia.
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Affiliation(s)
- Edouard Roussel
- Department of Digestive and Oncologic Surgery, Charles Nicolle University Hospital, Rouen Cedex, France.
- Department of Digestive Surgery, Rouen University Hospital, 1 Rue de Germont, Rouen Cedex, F-76031, France.
| | - Hugo Dupuis
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | - Julien Grosjean
- Department of Biomedical Informatics, Rouen University Hospital, Rouen, France
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé, INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, U1142, France
| | - Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | - Haitham Khalil
- Department of Digestive and Oncologic Surgery, Charles Nicolle University Hospital, Rouen Cedex, France
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Haque TF, Ghoreifi A, Sheybaee Moghaddam F, Kaneko M, Ginsberg D, Sotelo R, Gill I, Desai M, Aron M, Schuckman A, Daneshmand S, Djaladat H. Perioperative and extended outcomes of patients undergoing parastomal hernia repair following cystectomy and ileal conduit. World J Urol 2024; 42:482. [PMID: 39133311 PMCID: PMC11319381 DOI: 10.1007/s00345-024-05123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/10/2024] [Indexed: 08/13/2024] Open
Abstract
PURPOSE To report perioperative and long-term postoperative outcomes of cystectomy patients with ileal conduit (IC) urinary diversion undergoing parastomal hernia (PSH) repair. METHOD We reviewed patients who underwent cystectomy and IC diversion between 2003 and 2022 in our center. Baseline variables, including surgical approach of PSH repair and repair technique, were captured. Multivariable Cox regressionanalysis was performed to test for the associations between different variables and PSH recurrence. RESULTS Thirty-six patients with a median (IQR) age of 79 (73-82) years were included. The median time between cystectomy and PSH repair was 30 (14-49) months. Most PSH repairs (32/36, 89%) were performed electively, while 4 were due to small bowel obstruction. Hernia repairs were performed through open (n=25), robotic (10), and laparoscopic approaches (1). Surgical techniques included direct repair with mesh (20), direct repair without mesh (4), stoma relocation with mesh (5), and stomarelocation without mesh (7). The 90-day complication rate was 28%. In a median follow-up of 24 (7-47) months, 17 patients (47%) had a recurrence. The median time to recurrence was 9 (7-24) months. On multivariable analysis, 90-day complication following PSH repair was associated with an increased risk of recurrence. CONCLUSIONS In this report of one of the largest series of PSH repair in the Urology literature, 47% of patients had a recurrence following hernia repair with a median follow-up time of 2 years. There was no significant difference in recurrence rates when comparing repair technique or the use of open or minimally invasive approaches.
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Affiliation(s)
- Taseen F Haque
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Alireza Ghoreifi
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | | | - Masatomo Kaneko
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - David Ginsberg
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Rene Sotelo
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Anne Schuckman
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Urology Department, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Urology Department, University of Southern California, Los Angeles, CA, USA.
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum 2022; 65:1173-1190. [PMID: 35616386 DOI: 10.1097/dcr.0000000000002498] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Luan L, Liu Q, Cui C, Cheng Y, Zhang G, Li B. Surgical treatment strategy for recurrent parastomal hernia: Experiences from 17 cases. Front Surg 2022; 9:928743. [PMID: 35983552 PMCID: PMC9379134 DOI: 10.3389/fsurg.2022.928743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to investigate the surgical treatment strategy of recurrent parastomal hernia (PH) and show its safety, feasibility, and outcomes at a mid-term follow-up. Methods A total of 17 cases of recurrent PH treated at our hospital between January 2016 and October 2021 were included in this retrospective analysis. Patient characteristics were recorded, and the classification of PH, operative time, intraoperative blood loss, hernia repair techniques, follow-up times, complications, as well as recurrence were compared and analyzed. Results Altogether, 17 patients with recurrent PH underwent successful hernia repair via surgical treatment at The First Affiliated Hospital of Shandong First Medical University and Shandong University Qilu Hospital. No recurrence or severe complications were noted during follow-ups (mean 32.8 ± 3.77 [range 3–68] months). Conclusions For recurrent PH, selecting a suitable repair approach based on intraperitoneal conditions such as infection, abdominal adhesions, or the length of the bowel loop, can help in achieving better therapeutic results. The lap-redo + Sugarbaker technique is worth recommending when the appropriate conditions are met.
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Affiliation(s)
- Li Luan
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Postgraduate Department, Shandong First Medical University, Jinan, China
| | - Qiaonan Liu
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Postgraduate Department, Shandong University, Jinan, China
| | - Changjin Cui
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Postgraduate Department, Shandong First Medical University, Jinan, China
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Bo Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Correspondence: Bo Li
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Soomro FH, Azam S, Ganeshmoorthy S, Waterland P. An Analysis of the Risk Factors for the Development of Parastomal Hernia: A Single Institutional Experience. Cureus 2022; 14:e21470. [PMID: 35106255 PMCID: PMC8786562 DOI: 10.7759/cureus.21470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: To study the frequency of risk factors affecting the development of parastomal hernias in patients undergoing stoma formation. Study Design: A retrospective descriptive cross-sectional study. Duration of Study: This study was conducted at the Department of General Surgery between January 2017 to December 2020. Methodology: A total of 163 patients aged between 20 and 100 years and who required a stoma formation were included in the study. The patients with incomplete data and those lacking post-operative imaging were excluded. According to this selection criteria, 80 patients were excluded. The data was collected for all patients from the hospital database. This included patient’s demographic information, co-morbidities, pre-surgery patient characteristics, an indication of stoma formation, the location of stoma exit, type of surgery, associated comorbidities, subcutaneous fat thickness, and type of stoma formed. Data were analyzed using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Results: The mean age was 68.46 ± 16.50 years, with males in the majority: 48 (57.8%). Most of the patients, 53 (63.8%), had malignant disease. Post-stoma formation, a total of 38 (45.9%) patients developed parastomal hernias, mostly involving the sigmoid colon (n=62, 74.7%). However, there was a statistically significant relationship between paroxysmal sympathetic hyperactivity (PSH) incidence with non-trans-rectus stomas (trans-oblique n=07, junctional n=28) (OR 3.04, CI 1.23-7.5, p=0.014). Furthermore, malignancy was also not an independent predictor of PSH (OR 0.408, CI 0.15-1.2, p=0.056). All other risk factors included in this study were nonsignificant. Conclusion: Our study shows that the incidence of parastomal hernias is rising with a high rate demonstrated in our patients. There was no statistically significant association between patient-related preoperative and operative factors with increased risk of parastomal hernias in our population except for a non-trans-rectus stoma, which was identified as an independent risk factor for parastomal hernias. Based on our findings, we would recommend a trans-rectus stoma over all other stoma sites. However, a much larger study is needed to validate this finding further.
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The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia. MATERIALS 2021; 14:ma14051062. [PMID: 33668318 PMCID: PMC7956701 DOI: 10.3390/ma14051062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
A parastomal hernia is a common complication following stoma surgery. Due to the large number of hernial relapses and other complications, such as infections, adhesion to the intestines, or the formation of adhesions, the treatment of hernias is still a surgical challenge. The current standard for the preventive and causal treatment of parastomal hernias is to perform a procedure with the use of a mesh implant. Researchers are currently focusing on the analysis of many relevant options, including the type of mesh (synthetic, composite, or biological), the available surgical techniques (Sugarbaker’s, “keyhole”, or “sandwich”), the surgical approach used (open or laparoscopic), and the implant position (onlay, sublay, or intraperitoneal onlay mesh). Current surface modification methods and combinations of different materials are actively explored areas for the creation of biocompatible mesh implants with different properties on the visceral and parietal peritoneal side. It has been shown that placing the implant in the sublay and intraperitoneal onlay mesh positions and the use of a specially developed implant with a 3D structure are associated with a lower frequency of recurrences. It has been shown that the prophylactic use of a mesh during stoma formation significantly reduces the incidence of parastomal hernias and is becoming a standard method in medical practice.
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De Robles MS, Young CJ. Parastomal hernia repair with onlay mesh remains a safe and effective approach. BMC Surg 2020; 20:296. [PMID: 33234128 PMCID: PMC7688000 DOI: 10.1186/s12893-020-00964-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair. This study aims to describe a practical approach for PSH, particularly with onlay mesh repair using a lateral peristomal incision. METHODS This is a retrospective review of consecutive patients who underwent PSH repair between 2001 and 2018. RESULTS Seventy-six consecutive PSH with a mean follow-up of 93.1 months were reviewed. Repair was carried out for end colostomy (40%), end ileostomy (25%), ileal conduit (21%), loop colostomy (6.5%) end-loop colostomy (5%) and loop ileostomy (2.5%). The repair was performed either with a lateral peristomal incision (59%) or a midline incision (41%). Polypropylene mesh (86%), biologic mesh (8%) and composite mesh (6%) were used. Stoma relocation was done in 9 patients (12%). Eight patients (11%) developed postoperative wound complications. Recurrence occurred in 16 patients (21%) with a mean time to recurrence at 29.4 months. No significant difference in wound complication and recurrence was observed based on the type of stoma, incision used, type of mesh used, and whether or not the stoma was repaired on the same site or relocated. CONCLUSION Onlay mesh repair of PSH remains a practical and safe approach and could be an advantageous technique for high-risk patients. It can be performed using a lateral peristomal incision with low morbidity and an acceptable recurrence rate. However, for patients with significant adhesions and very large PSH, a midline approach with stoma relocation may also be considered.
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Affiliation(s)
- Marie Shella De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital Medical Centre, Suite G07/100 Carillon Avenue, Newtown, Sydney, NSW, 2042, Australia.
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital Medical Centre, Suite G07/100 Carillon Avenue, Newtown, Sydney, NSW, 2042, Australia
- Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
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Vettoretto N, Caprioli M, Botteri E. Emergency laparoscopic treatment of complicated parastomal hernias. MINERVA CHIR 2020; 75:313-319. [PMID: 33210527 DOI: 10.23736/s0026-4733.20.08462-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parastomal hernia is not a rare event. Being by definition a complication of ostomy creation, a parastomal hernia also carries the risk of becoming symptomatic and complicated. At present, there are not enough solid data in literature to allow an evidence-based approach to this condition and to its possible complications, especially in the emergency setting. The aim of this paper is to describe through a narrative review of the literature the different surgical approaches concerning parastomal hernias. In order to exemplify the emergency complications we also present two cases in which the watchful waiting approach eventually led to the necessity of urgent surgical treatment, due to bowel incarceration into the parastomal hernia. We chose to tailor the surgical plan on the patient's anatomic and clinical condition, pursuing the laparoscopic approach with two different surgical technique (Sugarbaker and keyhole), each time estimated by the operating surgeon to be the more suitable option for the patient. We acknowledge that laparoscopy can be an optimal choice for the emergency and elective treatment of parastomal hernias, whenever an appropriate know-how is present.
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Affiliation(s)
- Nero Vettoretto
- Department of Surgery, ASST Spedali Civili Brescia, Montichiari, Brescia, Italy
| | - Michela Caprioli
- Department of Surgery, ASST Spedali Civili Brescia, Montichiari, Brescia, Italy
| | - Emanuele Botteri
- Department of Surgery, ASST Spedali Civili Brescia, Montichiari, Brescia, Italy -
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Lin YW, Keller P, Davenport DL, Plymale MA, Totten CF, Roth JS. Parastomal Hernia Repair Outcomes: A Nine-Year Experience. Am Surg 2020. [DOI: 10.1177/000313481908500734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parastomal hernias (PHs) frequently complicate enterostomy creation. Decision for PH repair (PHR) is driven by patient symptoms due to the frequency of complications and recurrences. The European Hernia Society (EHS) PH classification is based on the PH defect size and the presence/ absence of concomitant incisional hernia. The aim of this study was to evaluate PHR outcomes based on EHS classification. An Institutional Review Board–approved retrospective review of a prospective database between 2009 and 2017 was performed. Patient demographics, enterostomy type, EHS classification, operative technique, and clinical outcomes (postoperative complications, 30-day readmission, and PH recurrence) were obtained. Cases were analyzed by EHS classifications I and II (SmallPH) versus III and IV (LargePH). Sixty-two patients underwent PHR (35: SmallPH, 27: LargePH). Patient groups (SmallPH vs LargePH) were similar based on American Society of Anesthesiologists Class III and obesity. Hernia recurrence was seen in 26 per cent of repairs with no difference between groups. The median recurrence-free survival was 3.9 years. There was no difference in superficial SSI, deep SSI, nonwound complications, or readmission between SmallPH and LargePH. Both small and large PHs experience similar outcomes after repair. Strategies to improve outcomes should be developed and implemented universally across all EHS PH classes.
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Affiliation(s)
- You Wei Lin
- College of Medicine, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Patrick Keller
- College of Medicine, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Daniel L. Davenport
- Department of Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Margaret A. Plymale
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Crystal F. Totten
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - John Scott Roth
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
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Outcomes of surgically managed recurrent parastomal hernia: the Sisyphean challenge of the hernia world. Hernia 2020; 25:133-140. [PMID: 32144507 DOI: 10.1007/s10029-020-02161-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The management of a recurrent (symptomatic) parastomal hernia (PSH) presents a dilemma. The aim of this study was to review the outcome of patients who underwent a recurrent PSH repair. METHODS Retrospective review of consecutive patients undergoing recurrent PSH repairs at a single institution between 2010 and 2019. Primary outcome recorded was recurrence. Secondary outcomes recorded were 30-day post-operative complications, surgical site occurrence (SSO) incidence and to assess if EHS classification altered with each recurrence. RESULTS Thirty-eight patients underwent 59 recurrent PSH repairs during the study period. Median number of PSH repairs per patient from ostomy formation was 2 (2-8). Post-operative complications occurred following 52.5% of repairs. Recurrence rate for all recurrent PSH hernia repairs was 45.7%, with a median follow-up of 58 months (0-115). A trend was seen towards a shorter PSH recurrence-free survival in those who had at least two previous PSH repairs at the start of the study period when compared to those who had less. Recurrence was not associated with operative urgency, type of repair, mesh type or SSO occurrence. A significant decrease in recurrence was seen with retro-rectus mesh placement when compared to onlay (p = 0.003). EHS classification did not change between each recurrence in 70.8% of patients. CONCLUSION Recurrence rates after recurrent PSH repair are high. The recurrence-free survival was worse after the second or more attempt at repair for recurrence. Further studies are warranted to explore prophylaxis, optimal repair method, and where re-recurrence occurs, the benefit of repeated surgical intervention.
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Abstract
Ostomy creation is a routine surgical procedure that has earned its place high in the surgeon's armamentarium in dealing with challenging situations. However, it is not without its complications. In this article, we review the common complications including parastomal hernia, prolapse, mucocutaneous junction separation with ischemia and stenosis, peristomal skin conditions, and infections. Additionally, we review conditions that arise in association with underlying Crohn's disease, such as peristomal inflammation, fistula formation, and pyoderma gangrenosum.
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Affiliation(s)
- Armen Aboulian
- Department of General Surgery, Kaiser Permanente Medical Center, Woodland Hills, California
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15
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Huang DY, Pan L, Chen QL, Cai XY, Fang J. Modified laparoscopic Sugarbaker repair of parastomal hernia with a three-point anchoring technique. World J Clin Cases 2018; 6:759-766. [PMID: 30510940 PMCID: PMC6265003 DOI: 10.12998/wjcc.v6.i14.759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/13/2018] [Accepted: 10/12/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.
METHODS A retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbaker hernia repair treatment. This modified technique included an innovative three-point anchoring and complete suturing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to evaluate the safety and efficacy of this modified technique.
RESULTS Of these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modified laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruction of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 (visual analog scale method) at postoperative day 1. Two patients developed postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period (6-22 mo, average 13 mo).
CONCLUSION The modified laparoscopic Sugarbaker repair could fix the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.
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Affiliation(s)
- Di-Yu Huang
- Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Abdominal Viscera of Zhejiang Province, Hangzhou 310016, Zhejiang Province, China
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Long Pan
- Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Abdominal Viscera of Zhejiang Province, Hangzhou 310016, Zhejiang Province, China
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Qi-Long Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiao-Yan Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jie Fang
- Department of General Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Jänes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, López-Cano M, Maggiori L, Mandalà V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Śmietański M, Szczepkowski M, Stabilini C, Muysoms FE. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2017; 22:183-198. [PMID: 29134456 DOI: 10.1007/s10029-017-1697-5] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 08/19/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. METHODS The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. RESULTS End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. CONCLUSION An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.
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Affiliation(s)
- S A Antoniou
- Department of General Surgery, University Hospital of Herakion, Crete, Greece.
| | - F Agresta
- Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy
| | - J M Garcia Alamino
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - D Berger
- Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden, Germany
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - H-T Brandsma
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - K Bury
- Department Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - J Conze
- Herniacenter Dr. Muschaweck/Dr. Conze, Munich, Germany
- Herniacenter Dr. Muschaweck/Dr. Conze, London, UK
- Department of General, Visceral and Transplant Surgery, University Hospital, RWTH Aachen University, Aachen, Germany
| | - D Cuccurullo
- Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera dei Colli, Naples, Italy
| | - U A Dietz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - R H Fortelny
- Certified Hernia Center, Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria
| | - C Frei-Lanter
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - B Hansson
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F Helgstrand
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - A Hotouras
- National Bowel Research Centre, The Royal London Hospital, London, United Kingdom
| | - A Jänes
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
| | - L F Kroese
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J R Lambrecht
- Surgical Department, Innlandet Hospital Trust, Gjøvik, Norway
| | - I Kyle-Leinhase
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - M López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - V Mandalà
- Department of General Surgery, Buccheri La Ferla Hospital, Palermo, Italy
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - M Prudhomme
- Digestive Surgery Department, CHU Nîmes, Nîmes, France
| | - T Rautio
- Department of Surgery, Division of Gastroenterology, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - N Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - M Śmietański
- 2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
- Department of General Surgery and Hernia Centre, District Hospital in Puck, Puck, Poland
| | - M Szczepkowski
- Department of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
- Clinical Department of General and Colorectal Surgery, Bielanski Hospital, Warsaw, Poland
| | - C Stabilini
- Department of Surgery, University of Genoa, Genoa, Italy
| | - F E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
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Tastaldi L, Haskins IN, Perez AJ, Prabhu AS, Rosenblatt S, Rosen MJ. Single center experience with the modified retromuscular Sugarbaker technique for parastomal hernia repair. Hernia 2017; 21:941-949. [DOI: 10.1007/s10029-017-1644-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/20/2017] [Indexed: 01/11/2023]
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Beffa LR, Warren JA, Cobb WS, Knoedler B, Ewing JA, Carbonell AM. Open Retromuscular Repair of Parastomal Hernias with Synthetic Mesh. Am Surg 2017. [DOI: 10.1177/000313481708300845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test. Values of P < 0.05 were considered significant. Forty-six patients underwent retromuscular PH repair with permanent synthetic mesh. There were 26 patients with colostomies and 20 with ileostomies. All the patients were repaired using a keyhole retromuscular technique and direct passage of stoma through mesh. Transversus abdominis release was performed in 65.2 per cent of cases. Permanent synthetic polypropylene mesh was used in all cases. Surgical site occurrence occurred in 47.8 per cent of patients, SSI in 17.4 per cent, and hernia recurrence in 21.7 per cent. Resiting the stoma yielded the highest rate of SSI (40%) compared with leaving the stoma in situ (11.8%) or rematuring the stoma (0%; P = 0.011). Open keyhole retromuscular PH repair of PH with permanent synthetic mesh is safe, effective, and durable.
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Affiliation(s)
- Lucas R. Beffa
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Jeremy A. Warren
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - William S. Cobb
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Bryan Knoedler
- University of South Carolina School of Medicine, Greenville, South Carolina
| | - Joseph A. Ewing
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
| | - Alfredo M. Carbonell
- Greenville Health System, Division of Minimal Access Surgery, Greenville, South Carolina
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Lykke A, Andersen JFB, Jorgensen LN, Mynster T. Prevention of parastomal hernia in the emergency setting. Langenbecks Arch Surg 2017; 402:949-955. [PMID: 28612116 DOI: 10.1007/s00423-017-1596-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/29/2017] [Indexed: 01/08/2023]
Abstract
AIM This study assessed safety and efficacy associated with hernia prophylaxis using a retromuscular slowly resorbable synthetic mesh for stoma reinforcement. METHOD This was a cohort study with a historic reference group. The study took place in a high-volume surgical department. During a 2-year period (July 2012-July 2014), we included 109 patients undergoing emergency surgery with formation of ileostomy or colostomy. All patients received a retromuscular slowly resorbable synthetic mesh (TIGR®, Novus Scientific) at the stoma site. The reference group included 117 patients who underwent emergency stoma formation without a prophylactic mesh in the 2-year period prior to July 2012. The primary endpoint was effect on prevention of parastomal hernia within 1 year. Secondary endpoints were 30-day and 1-year complications including mortality. RESULTS The operative field was contaminated or dirty in 48% of the procedures. Operative time was significantly longer in the mesh group. The cumulative incidences of parastomal hernia at 1 year for the control and the mesh group were 8 and 7% (p = 0.424), respectively. The postoperative 30-day and 1-year rate of complications, reoperations and mortality were not different between the two groups. No patients underwent removal of the mesh and no clinical mesh infections were seen. CONCLUSION Use of a resorbable synthetic mesh during emergency ostomy formation showed no significant preventive effect on formation of parastomal hernia after 1 year. Although surgery was often conducted in a severely contaminated field, the procedure was without significantly increased complication rate.
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Affiliation(s)
- Anna Lykke
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - Johnny F B Andersen
- Department of Radiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - Tommie Mynster
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.
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20
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Prophylactic mesh placement for the PREvention of paraSTOmal hernias: The PRESTO systematic review and meta-analysis. PLoS One 2017; 12:e0171548. [PMID: 28182642 PMCID: PMC5300283 DOI: 10.1371/journal.pone.0171548] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022] Open
Abstract
Background Parastomal hernia (PH) is the most common complication after ostomy formation. Prophylactic mesh placement may be effective in reducing the rate of PH at the stoma site. The aims of this systematic review were to summarize the evidence with regard to the safety and effectiveness in comparison with the standard procedure without mesh placement and to identify important risk constellations. Method A systematic literature search was performed in PubMed, EMBASE and the Cochrane library with no language or date restrictions. Randomized (RCTs) and non-randomized controlled trials (nRCTs) were included. The main outcomes of interest were PH (primary outcome) rate and stoma-related complications (secondary outcomes) such as stenosis or fistula. Statistical analysis included meta-analyses of pooled data and subgroup analyses. Results Eleven trials (eight RCTs; three nRCTs) with a total of 755 patients were included. PH rate varied from 0% to 59% in the intervention and from 20% to 94% in the control group. RCTs showed a significant reduction of PH rate in the mesh group (OR 0.24; 95% CI 0.10 to 0.58, p = 0.034), whereas included nRCTs did not. No significant differences were observed in postoperative complication rates. Subgroup analyses showed superiority of non-absorbable meshes and sublay mesh positioning in open surgery. Conclusion Prophylactic mesh placement is safe and reduces PH rate. A recommendation for prophylactic non-absorbable meshes in a sublay position can be made for patients undergoing open colorectal operations with end-ostomies. Further research endeavors should focus on patient-oriented outcomes, not only PH rate, with respect to tailored treatment in specific patient populations.
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21
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Krogsgaard M, Pilsgaard B, Borglit TB, Bentzen J, Balleby L, Krarup PM. Symptom load and individual symptoms before and after repair of parastomal hernia: a prospective single centre study. Colorectal Dis 2017; 19:200-207. [PMID: 27248700 DOI: 10.1111/codi.13403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/11/2016] [Indexed: 02/08/2023]
Abstract
AIM The symptom load and individual symptoms before and after repair of parastomal hernia were investigated. METHOD Stoma-related symptoms were prospectively recorded before repair of a parastomal hernia and at 10 days and 6 months postoperatively: leakage, skin problems, difficulty with the appliance, limitation of activity, difficulty with clothing, cosmetic complaints, social restriction, erratic action of the stoma, a bearing-down sensation at the site of the stoma and pain. Episodes of intermittent bowel obstruction and difficulty with irrigation were also recorded. Patients were seen at 1, 2 and 3 years and were examined for recurrent parastomal herniation. RESULTS Of 131 consecutive patients referred to a specialized centre for treatment of parastomal bulging, 61 underwent parastomal hernia repair. Forty-eight patients were treated with the Sugarbaker technique. Six different symptoms were present in more than half the patients before surgery. The overall symptom load decreased significantly from a median of 4 [interquartile range (IQR) 2.5-6] preoperatively to 2 (IQR 1-3) on postoperative day 10 and 1 (IQR 0-2) at 6 months, P < 0.001. The number of symptoms decreased in 93% of patients; in 5% there was no change and in 2% symptoms increased. Skin problems and leakage were the only symptoms that were not significantly reduced. The overall recurrence rate of herniation was 5/48 (10%) at a median of 12 (IQR 6-24) months. CONCLUSION The preoperative symptom load was high and this fell after repair in over 90% of patients. Recurrence occurred in 10% of patients within 2 years of repair. The study emphasizes the importance of detailed knowledge of the symptoms of parastomal hernia when addressing and managing patients' problems and complaints.
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Affiliation(s)
- M Krogsgaard
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - B Pilsgaard
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - T B Borglit
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - J Bentzen
- Research Centre for Prevention and Health, Glostrup, Denmark
| | - L Balleby
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - P M Krarup
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark
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22
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Glasgow SC, Dharmarajan S. Parastomal Hernia: Avoidance and Treatment in the 21st Century. Clin Colon Rectal Surg 2016; 29:277-84. [PMID: 27582655 DOI: 10.1055/s-0036-1584506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Despite medical and surgical advances leading to increased ability to restore or preserve gastrointestinal continuity, creation of stomas remains a common surgical procedure. Every ostomy results in a risk for subsequent parastomal herniation, which in turn may reduce quality of life and increase health care expenditures. Recent evidence-supported practices such as utilization of prophylactic reinforcement, attention to stoma placement, and laparoscopic-based stoma repairs with mesh provide opportunities to both prevent and successfully treat parastomal hernias.
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Affiliation(s)
- Sean C Glasgow
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; USAF Center for the Sustainment of Trauma and Resuscitative Skills (C-STARS), St. Louis, Missouri
| | - Sekhar Dharmarajan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; John Cochrane VA Medical Center, St. Louis, Missouri
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New minimally invasive technique of parastomal hernia repair - methods and review. Wideochir Inne Tech Maloinwazyjne 2015; 10:1-7. [PMID: 25960785 PMCID: PMC4414113 DOI: 10.5114/wiitm.2015.50052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 01/10/2015] [Accepted: 01/14/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Parastomal hernia is described as the most common complication in patients with ostomy. It is reported that its incidence varies from 3% to 39% for colostomies and 0 to 6% for ileostomies. Surgical repair remains the treatment of choice. There are three types of surgical treatment - fascial repair, stoma relocation and repair using prosthetic mesh via a laparoscopic or open approach. Recently there have been several meta-analyses and systematic reviews aiming to compare the results of surgical treatment, and the authors agreed that the quality of evidence precludes firm conclusions. AIM To describe the novel concept of parastomal hernia repair - HyPER/SPHR technique (hybrid parastomal endoscopic re-do/Szczepkowski parastomal hernia repair) and its early results in 12 consecutive cases. MATERIAL AND METHODS Twelve consecutive patients were operated on due to parastomal hernia using the new HyPER hybrid technique between June 2013 and May 2014. The patients' condition was evaluated during the perioperative period, 6 weeks and then every 3 months after surgery. RESULTS After 6 weeks of follow-up we have not observed any mesh-related complications. All 12 patients were examined 3 months and 6 months after repair surgery for evaluation. No recurrence, stoma site infection or stoma-related problems were found. None of the patients complained of pain and none of them needed to be hospitalized again. Reported quality of life on a 0-10 scale after 6 weeks of follow-up was 8 (range: 7-10). CONCLUSIONS The HyPER procedure for treatment of parastomal hernias proposed by the authors is a safe and feasible surgical technique with a high patient satisfaction rate and a low number of complications. The hybrid procedure seems to be a promising method for parastomal hernia repair.
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24
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O'Neill CH, Borrazzo EC, Hyman NH. Parastomal hernia repair. J Gastrointest Surg 2015; 19:766-9. [PMID: 25504464 DOI: 10.1007/s11605-014-2717-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/27/2014] [Indexed: 01/31/2023]
Abstract
Parastomal herniation is a common clinical occurrence. Historically, there has been a high recurrence rate after repair, and conservative management is usually recommended for patients with mild symptoms. When operative intervention is warranted, we opt for a laparoscopic mesh sublay over the fascial defect and lateralization of the stoma limb, or the Sugarbaker technique. In patients who are considered poor risk for laparoscopy/laparotomy requiring repair, we perform a fascial onlay with mesh utilizing an anterior circumstomal approach.
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Affiliation(s)
- Conor H O'Neill
- Division of Gastrointestinal Surgery, Department of Surgery, University of Vermont, Burlington, VT, USA
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25
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Hwang GS, Hanna MH, Carmichael JC, Mills SD, Pigazzi A, Stamos MJ. Repair of complex parastomal hernias. Tech Coloproctol 2015; 19:127-33. [PMID: 25732736 DOI: 10.1007/s10151-015-1293-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/13/2015] [Indexed: 11/26/2022]
Abstract
Development of parastomal hernias (PH) is very common after stoma formation and carries a risk of subsequent bowel incarceration, obstruction and strangulation. The management of PH remains a challenge for the colorectal surgeon, and there are currently no standardized guidelines for the treatment of PH. Even more difficult is the management of complex parastomal hernias (CPH). We conducted a review of the literature to identify recent developments in the treatment of CPH, including analysis of the use of synthetic and biologic mesh prostheses, method of mesh placement and surgical approach.
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Affiliation(s)
- G S Hwang
- Department of Surgery, Irvine School of Medicine, University of California, Irvine, CA, USA
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26
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Aquina CT, Iannuzzi JC, Probst CP, Kelly KN, Noyes K, Fleming FJ, Monson JRT. Parastomal hernia: a growing problem with new solutions. Dig Surg 2014; 31:366-76. [PMID: 25531238 DOI: 10.1159/000369279] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/19/2014] [Indexed: 12/10/2022]
Abstract
Parastomal hernia is one of the most common complications following stoma creation and its prevalence is only expected to increase. It often leads to a decrease in the quality of life for patients due to discomfort, pain, frequent ostomy appliance leakage, or peristomal skin irritation and can result in significantly increased healthcare costs. Surgical technique for parastomal hernia repair has evolved significantly over the past two decades with the introduction of new types of mesh and laparoscopic procedures. The use of prophylactic mesh in high-risk patients at the time of stoma creation has gained attention in lieu of several promising studies that have emerged in the recent days. This review will attempt to demonstrate the burden that parastomal hernias present to patients, surgeons, and the healthcare system and also provide an overview of the current management and surgical techniques at both preventing and treating parastomal hernias.
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Affiliation(s)
- Christopher T Aquina
- Surgical Health Outcomes & Research Enterprise (S.H.O.R.E.), Division of Colorectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, N.Y., USA
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27
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Gillern S, Bleier JIS. Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials. Clin Colon Rectal Surg 2014; 27:162-71. [PMID: 25435825 DOI: 10.1055/s-0034-1394090] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Parastomal hernia is a prevalent problem and treatment can pose difficulties due to significant rates of recurrence and morbidities of the repair. The current standard of care is to perform parastomal hernia repair with mesh whenever possible. There exist multiple options for mesh reinforcement (biologic and synthetic) as well as surgical techniques, to include type of repair (keyhole and Sugarbaker) and position of mesh placement (onlay, sublay, or intraperitoneal). The sublay and intraperitoneal positions have been shown to be superior with a lower incidence of recurrence. This procedure may be performed open or laparoscopically, both having similar recurrence and morbidity results. Prophylactic mesh placement at the time of stoma formation has been shown to significantly decrease the rates of parastomal hernia formation.
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Affiliation(s)
- Suzanne Gillern
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Joshua I S Bleier
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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28
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Abstract
Around 11 000 people in the UK have a urostomy. A urostomy is now usually carried out for bladder cancer. Most urostomists are older men and around half require assistance with routine care. Complications such as parastomal skin soreness are common. Community nurses can work with urostomists and formal and informal carers to encourage and enable the person to manage their urostomy independently whenever possible and provide support, advice and help when complications occur. This article provides an overview of effective care and possible complications.
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Affiliation(s)
- Linda Nazarko
- Consultant Nurse and Lead, Community IV Services and Dementia, Ealing NHS Trust
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29
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Abstract
The construction of an intestinal stoma is fraught with complications and should not be considered a trivial undertaking. Serious complications requiring immediate reoperations can occur, as can minor problems that will subject the patient to daily and nightly distress. Intestinal stomas undoubtedly will dramatically change lifestyles; patients will experience physiologic and psychologic detriment with stoma-related problems, however minor they may seem. Common complications include poor stoma siting, high output, skin irritation, ischemia, retraction, parastomal hernia (PH), and prolapse. Surgeons should be cognizant of these complications before, during, and after stoma creation, and adequate measures should be taken to avoid them. In this review, the authors highlight these often seen problems and discuss management and prevention strategies.
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Affiliation(s)
- Michael Kwiatt
- Division of Colon and Rectal Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Michitaka Kawata
- Division of Colon and Rectal Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, New Jersey
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30
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Gregg ZA, Dao HE, Schechter S, Shah N. Paracolostomy hernia repair: who and when? J Am Coll Surg 2014; 218:1105-12. [PMID: 24702889 DOI: 10.1016/j.jamcollsurg.2014.01.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paracolostomy hernia repair (PHR) can be a challenging procedure associated with significant morbidity and high recurrence rates. We sought to analyze the complication rate and 30-day mortality among patients undergoing PHR. STUDY DESIGN This is a retrospective analysis of patients with PHR, based on Current Procedural Terminology code 44346, using the NSQIP database from 2005 to 2008. Univariate analysis of 30-day outcomes after both emergent and nonemergent PHR in patients greater than or less than 70 years old was completed. RESULTS There were 519 patients who underwent PHR (mean age, 63.9 years old, female, 55.9%). Emergency PHR, performed in 59 patients (11.4%), was associated with increased rates of organ space surgical site infection (SSI) (8.5% vs 0.9%, p = 0.0014), pneumonia (18.6% vs 2.6%, p ≤ 0.0001), septic shock (13.6% vs 2.6%, p = 0.0007), total morbidity (50.8% vs 2.6%, p ≤ 0.0001), and death (10.2% vs 0.9%; p = 0.0002). In patients older than 70 years, emergent PHR amplified these differences: organ space SSI (13.8% vs 1.2%, p = 0.0054); pneumonia (27.6% vs 3.7%; p = 0.0002), septic shock (17.2% vs 4.3%; p = 0.02), and mortality (20.7% vs 1.9%; p = 0.0005). CONCLUSIONS This study revealed that most PHRs are performed electively. Although elective repair remains a relatively safe procedure, even in the elderly, emergency PHR is associated with increased morbidity, especially pulmonary and septic complications, and higher mortality. These results are amplified among patients older than 70 years undergoing emergent repair. These findings suggest that greater consideration should be given to elective repair of paracolostomy hernias in the elderly because emergency repair is associated with considerable risk and worse outcomes.
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Affiliation(s)
- Zachary A Gregg
- Division of Colorectal Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Haisar E Dao
- Division of Colorectal Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Steven Schechter
- Division of Colorectal Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Nishit Shah
- Division of Colorectal Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
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Al Shakarchi J, Williams JG. Systematic review of open techniques for parastomal hernia repair. Tech Coloproctol 2014; 18:427-32. [PMID: 24448678 DOI: 10.1007/s10151-013-1110-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
Parastomal hernia formation is common following formation of an abdominal stoma, with the risk of subsequent incarceration, obstruction and strangulation. Current treatment options include non-operative management, stoma relocation and fascial repair with or without mesh. The purpose of this systematic review was to evaluate the effectiveness and safety of open mesh repair of a parastomal hernia and to compare open non-mesh fascial repair with mesh techniques of parastomal hernia repair. Electronic databases were searched for studies comparing the two surgical techniques in accordance with preferred reporting items for systematic reviews and meta-analyses. The primary outcome of the study was the comparison of recurrence rates of parastomal hernia for each technique. Secondary outcomes included comparison of mortality, wound infection, mesh infection and any other complication. Twenty-seven studies of parastomal hernia repair were included and divided into two subgroups for open mesh repair and non-mesh fascial repair. Non-mesh fascial repair resulted in a high recurrence rate (around 50%). Reported recurrence rates for mesh repair were substantially lower, at 7.9-14.8%, depending on the position of the mesh in relation to the abdominal fascia and the length of follow-up. Morbidity and mortality did not differ significantly between the techniques used to repair a parastomal hernia. This study shows that mesh repair of a parastomal hernia is safe and significantly reduces the rate of recurrence compared with sutured repair, which should only be used in exceptional circumstances. There is insufficient evidence to determine which mesh technique (onlay, sublay or underlay) is most successful in terms of recurrence rates and morbidity.
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Affiliation(s)
- J Al Shakarchi
- Department of Surgery, Sandwell Hospital, West Bromwich, UK,
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Suwa K, Hanyu K, Suzuki T, Nakajima S, Okamoto T, Yanaga K. Parastomal hernias successfully repaired using a modified components separation method: two case reports. J Med Case Rep 2013; 7:180. [PMID: 23830070 PMCID: PMC3711726 DOI: 10.1186/1752-1947-7-180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Parastomal hernia is a frequent complication after enterostomy formation. A repair using prosthetic mesh by way of a laparoscopic or open transabdominal approach is usually recommended, however, other procedures may be done if the repair is to be performed in a contaminated environment or when the abdominal cavity of the patient is difficult to enter due to postsurgical dense adhesion. The components separation method, which was introduced for non-transabdominal and non-prosthetic ventral hernia repair, solves such problems. Case presentation Case 1. A 79-year-old Japanese woman who underwent total cystectomy with ileal conduit for bladder cancer presented with a parastomal hernia, which was repaired using a keyhole technique. Simultaneously, an incisional hernia in the midline was repaired with a prosthetic mesh. One year after her hernia surgery, a recurrence occurred lateral to the stoma, but it was believed to be difficult to enter the peritoneal cavity because of the wide placement of mesh. Therefore, surgery using the components separation method was performed. Case 2. A 72-year-old Japanese man underwent an abdominoperineal resection for rectal cancer. At 5 and 12 months after his operation, a perineal hernia and an incisional hernia in the midline were repaired with prosthesis using a transabdominal approach, respectively. Three years after his rectal surgery, a parastomal hernia developed lateral to the stoma. For the same reason as case 1, surgery using the components separation method was performed. No recurrence was observed in either case as of 40 and 8 months after the last repair, respectively. Conclusion The components separation method is a novel and effective technique for parastomal hernia repair, especially in cases following abdominal polysurgery or midline incisional hernia repairs using large pieces of mesh. To the best of our knowledge, this is the first report in English on the application of the components separation method for parastomal hernia repair.
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Abstract
Stomas are created for a wide range of indications such as temporary protection of a high-risk anastomosis, diversion of sepsis, or permanent relief of obstructed defecation or incontinence. Yet this seemingly benign procedure is associated with an overall complication rate of up to 70%. Therefore, surgeons caring for patients with gastrointestinal diseases must be proficient not only with stoma creation but also with managing postoperative stoma-related complications. This article reviews the common complications associated with ostomy creation and strategies for their management.
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Affiliation(s)
- Andrea C Bafford
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD 21230, USA
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Brandsma HT, Hansson BME, V-Haaren-de Haan H, Aufenacker TJ, Rosman C, Bleichrodt RP. PREVENTion of a parastomal hernia with a prosthetic mesh in patients undergoing permanent end-colostomy; the PREVENT-trial: study protocol for a multicenter randomized controlled trial. Trials 2012. [PMID: 23186083 PMCID: PMC3576295 DOI: 10.1186/1745-6215-13-226] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Parastomal hernia is a common complication of a colostomy. Ultimately, one-third of patients with a parastomal hernia will need surgical correction due to frequent leakage or life-threatening bowel obstruction or strangulation. However, treatment remains a challenge resulting in high recurrence rates. Two single center trials demonstrated that the frequency of parastomal hernias decreases by prophylactic placement of a mesh around the stoma at the time of formation. Unfortunately, both studies were small-sized, single-center studies and with these small numbers less common complications could be missed which were the reasons to initiate a prospective randomized multicenter trial to determine if a retromuscular, preperitoneal mesh at the stoma site prevents parastomal hernia and does not cause unacceptable complications. METHODS One hundred and fifty patients undergoing open procedure, elective formation of a permanent end-colostomy will be randomized into two groups. In the intervention group an end-colostomy is created with placement of a preperitioneal, retromuscular lightweight monofilament polypropylene mesh, and compared to a group with a traditional stoma without mesh. Patients will be recruited from 14 teaching hospitals in the Netherlands during a 2-year period. Primary endpoint is the incidence of parastomal hernia. Secondary endpoints are stoma complications, cost-effectiveness, and quality of life. Follow-up will be performed at 3 weeks, 3 months and at 1, 2, and 5 years. To find a difference of 20% with a power of 90%, a total number of 134 patients must be included. All results will be reported according to the CONSORT 2010 statement. DISCUSSION The PREVENT-trial is a multicenter randomized controlled trial powered to determine whether prophylactic placement of a polypropylene mesh decreases the incidence of a parastomal hernia versus the traditional stoma formation without a mesh. TRIAL REGISTRATION The PREVENT-trial is registered at: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2018.
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Affiliation(s)
- Henk-Thijs Brandsma
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
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35
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36
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Heo SC, Oh HK, Song YS, Seo MS, Choe EK, Ryoo S, Park KJ. Surgical treatment of a parastomal hernia. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:174-9. [PMID: 21980587 PMCID: PMC3180597 DOI: 10.3393/jksc.2011.27.4.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 08/03/2011] [Indexed: 11/30/2022]
Abstract
Purpose Parastomal hernia is a major complication of an intestinal stoma. This study was performed to compare the results of various operative methods to treat parastomal hernias. Methods Results of surgical treatment for parastomal hernias (postoperative recurrence, complications and postoperative hospital stays) were surveyed in 39 patients over an 11-year period. The patients enrolled in this study underwent surgery by a single surgeon to exclude surgeon bias. Results Seventeen patients were male, and twenty-two patients were female. The mean age was 65.9 years (range, 36 to 86 years). The stomas were 35 sigmoid-end-colostomies (90%), 2 loop-colostomies (5%), and 2 double-barrel-colostomies. Over half of the hernias developed within two years after initial formation. Stoma relocation was performed in 8 patients, suture repair in 14 patients and mesh repair in 17 patients. Seven patients had recurrence of the hernia, and ten patients suffered from complications. Postoperative complications and recurrence were more frequent in stoma relocation than in suture repair and mesh repair. Emergency operations were performed in four patients (10.3%) with higher incidence of complications but not with increased risk of recurrence. Excluding emergency operations, complications of relocations were not higher than those of mesh repairs. Postoperative hospital stays were shortest in mesh repair patients. Conclusion In this study, mesh repair showed low recurrence and a low complication rate with shorter hospital stay than relocation methods, though these differences were not statistically significant. Further studies, including randomized trials, are necessary if more reliable data on the surgical treatment of parastomal hernias are to be obtained.
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Affiliation(s)
- Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Slater NJ, Hansson BME, Buyne OR, Hendriks T, Bleichrodt RP. Repair of parastomal hernias with biologic grafts: a systematic review. J Gastrointest Surg 2011; 15:1252-8. [PMID: 21360207 PMCID: PMC3116129 DOI: 10.1007/s11605-011-1435-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 01/26/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias. METHODS Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms 'paracolostomy', 'paraileostomy', 'parastomal', 'colostomy', 'ileostomy', 'hernia', 'defect', 'closure', 'repair' and 'reconstruction' were used. Selection of studies and assessment of methodological quality were performed with a modified MINORS index. All reports on repair of parastomal hernias using a collagen-based biologic scaffold to reinforce or bridge the defect were included. Outcomes were recurrence rate, mortality and morbidity. RESULTS Four retrospective studies with a combined enrolment of 57 patients were included. Recurrence occurred in 15.7% (95% confidence interval [CI] 7.8-25.9) of patients and wound-related complications in 26.2% (95% CI 14.7-39.5). No mortality or graft infections were reported. CONCLUSIONS The use of reinforcing or bridging biologic grafts during parastomal hernia repair results in acceptable rates of recurrence and complications. However, given the similar rates of recurrence and complications achieved using synthetic mesh in this scenario, the evidence does not support use of biologic grafts.
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Affiliation(s)
- Nicholas Jonathan Slater
- Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Abstract
The reparation of parastomal hernias and their recurrence remain problematic although the implementation of mesh techniques has lowered recurrences rates. Conventional surgical techniques include suture repair, relocation of the stoma as well as diverse hernia repair procedures with mesh implantation. Suture repair has been abandoned due to its high recurrence rate. Simple relocation is not recommended because of high rates of recurrent parastomal hernias. Conventional hernia repair using mesh implants is classified according to the mesh position into epifascial (onlay), retromuscular (sublay) and intraperitoneal (IPOM) techniques. Furthermore, a combination of relocation with additional mesh enforcement is also possible. The value of the different mesh techniques and of new biological mesh prostheses must be evaluated in randomized controlled studies.
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Affiliation(s)
- R Rosch
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik der RWTH Aachen, Deutschland.
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