Patients Undergoing Parastomal Hernia Repair Using the Americas Hernia Society Quality Collaborative: A Prospective Cohort Study

Abstract

Parastomal hernia is the most common complication after stoma creation. It can create significant morbidity and is associated with a lower quality of life. Current parastomal hernia repair techniques and outcomes are not well characterized. We aimed to describe patient characteristics, operative techniques, and outcomes of patients undergoing parastomal hernia repair. Patients in the Americas Hernia Society Quality Collaborative (AHSQC) ≥18 years old, who underwent parastomal hernia repair were identified. Descriptive statistics were performed for patient demographics, preoperative characteristics, operative details, 30-day follow-up, and patient-reported outcomes. The surgical techniques used in parastomal hernia repair and postoperative outcomes were described, and predictors of open vs minimally invasive surgery (MIS) and type of mesh used were analyzed. We identified 672 patients in the AHSQC who underwent parastomal hernia repair between 2013 and Nov 2017. Almost all operations were elective, 22% of patents had their stoma reversed, and 94% of repairs used mesh. Elective status and surgeon practice type were associated with use of synthetic mesh. A surgeon's preference for MIS, defect size, and age were associated with use of an MIS approach. Quality of life scores improved for patients who completed a postoperative questionnaire. This is the first multi-institutional report of parastomal hernia repair using prospective data complete with operative details. Parastomal hernia repair remains a difficult operation without a clear best practice. Multiple factors appear to influence operative approach. Surgical treatment may improve quality of life at 6 to 12 months postoperatively.