«A stoma comes seldom alone» … the parastomal hernia in the 21st century - a surgical update

Abstract

«A stoma comes seldom alone» … the parastomal hernia in the 21st century - a surgical update Abstract. Parastomal hernias (PSH) remain a challenge for surgeons of the 21st century. Almost one in two patients will develop a PSH within 24 months of stoma formation and surgical repair is associated with high recurrence rates. Multiple open / laparoscopic repair strategies have been described, however, due to heterogeneity within the literature and a lack of robust evidence, guidelines are difficult to establish. Direct suture repair of PSH has demonstrated higher recurrence rates than mesh techniques, and so mesh repair is highly advocated. Looking at the different mesh techniques in terms of recurrence, open onlay and laparoscopic keyhole repair appear to have less favourable results than open sublay / underlay repair and the laparoscopic Sugarbaker technique. Use of prophylactic synthetic mesh at the time of formation of a definitive end colostomy (typically in patients undergoing abdomen-perineal resection) has demonstrated encouraging results and is therefore currently recommended. Technical innovations with robotic surgery make minimally invasive sublay repairs possible and have the potential to offer new dimensions of parastomal hernia repair.