Abstract
BackgroundParastomal 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.MethodsThis is a retrospective review of consecutive patients who underwent PSH repair between 2001 and 2018.ResultsSeventy-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.ConclusionOnlay 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.
Highlights
Parastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair
The recurrence rate of PSH is lowest after mesh repair (0–33%), whereas
This study describes a practical approach for PSH, primarily with synthetic onlay mesh repair using a lateral peristomal incision
Summary
Parastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair. Parastomal hernia (PSH) is a common complication of stoma formation in colorectal surgery, with an incidence up to 50% [1,2,3]. 11–70% of patients undergo surgery due to increasing hernia size, problems with the stomal appliance, discomfort, pain, and cosmetic dissatisfaction [2]. These treatment percentages vary significantly because surgeons are often reluctant to repair a PSH due to the high recurrence rate, complicated operation, and comorbidity of patients [2, 3]. The recurrence rate of PSH is lowest after mesh repair (0–33%), whereas
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