Diagnosis Of Parastomal Hernia Research Articles

Effect of Sublay Preventive Mesh for Terminal Colostomy on Symptoms and Quality of Life in Patients With Parastomal Hernia: A Post-Hoc Analysis of the GRECCAR 7 Cohort.

Recent randomized clinical trials and meta-analyses confirm that the use of a prophylactic mesh doesn't significantly reduce the parastomal hernia rate. Data about the benefits of these meshes concerning the symptoms of the parastomal hernia lack in the existing literature. The aim of this study was to perform a post-hoc analysis of the patients presenting parastomal hernia from the GRECCAR 7 randomized clinical trials cohort on whether the presence or absence of the mesh influenced the symptoms, the quality of life and complications of patients with parastomal hernias. We studied the parastomal hernia related symptoms among the two groups of the GRECCAR 7 randomized clinical trial, with or without prophylactic mesh at the time of the index surgery. Data were retrospectively extracted and analyzed from the GRECCAR 7 database. Patients diagnosed with a parastomal hernia during the two years of the GRECCAR 7 study. Several prospectively collected data about the symptoms were studied among this population. We also studied the average interval between parastomal hernia repair surgery and both index surgery and diagnosis of parastomal hernia. Among the 199 patients included in the GRECCAR study, 36 patients (35.6%) were diagnosed with clinical and/or radiological parastomal hernia in the non-mesh group at 2 years follow-up and 33 (33.7%) in the mesh group, without statistically significant difference (p = 0.89). None of the studied symptoms showed any statistically significant difference between the groups. This study relies on a relatively small number of patients, and although data were prospectively collected, we lacked some details about the categorization of the parastomal hernias. We believe that the use of a prosthetic mesh in a sublay position to prevent parastomal hernia in terminal end colostomy patients should no longer be recommended. See Video Abstract.

Risk Factors for Parastomal Hernia Associated with Covering Stoma in Rectal Surgery

The definitive risk factors for parastomal hernia (PSH), a complication of stoma construction that can lead to severe morbidity, remain unclear. Therefore, this study aimed to determine risk factors for PSH after rectal surgery in Japanese patients. We retrospectively included 134 patients who underwent rectal tumor surgery and covering stoma construction between January 2012 and October 2016 in our department. Eleven variables, including the presence of sarcopenia determined by computed tomography (CT), were studied as risk factors for PSH. The diagnosis of PSH was based on CT obtained during follow-up after surgery. Our results indicated that the incidence of PSH was 16.4% (22/134). Multivariate analysis revealed that age ≥ 65 years (odds ratio [OR], 9.53; 95% confidence interval [CI], 2.11–71.3; P = 0.009), sarcopenia (OR, 5.08; 95%CI, 1.10–25.8; P = 0.039), umbilical subcutaneous fat thickness ≥ 21.3 mm (OR, 7.91; 95%CI, 2.02–38.9; P = 0.0051), and colostomy (OR, 9.02; 95%CI, 1.58–64.3; P = 0.018) were independent risk factors for PSH. Therefore, older age, sarcopenia, thick subcutaneous fat, and colostomy were risk factors for PSH. With the increasing age and sarcopenia incidence in recent years, reduction of risk factors and preventative approaches for PSH are necessary before rectal surgery.

Interpretation of 2017 European Hernia Society Guidelines for The Prevention and Treatment of Parastomal Hernias

European Hernia Society issued a guideline for the prevention and treatment of parastomal hernias in 2017, which is the first international guideline for the parastomal hernia. This guideline proposed 12 problems about incidence, diagnosis and treatment, and discussed these problems in depth. The main contents of this guideline are summarized as follows: (1) End colostomy is associated with a higher incidence of parastomal hernia compared to other types of stomas. (2) Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. (3) The use of the European Hernia Society classification for uniform research reporting is recommended. (4) There is insufficient evidence on the policy in watchful waiting. (5) There is insufficient evidence on the route and location of stoma construction, and the size of the aperture. (6) 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.(7) It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. (8) So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, most data in this guideline were retrospective without high level evidence. A lot of questions remain controversial and more high-level evidence are expected to solve these problems.

Ultrasonographic findings in patients with peristomal bulging

Aim. The aim of this study was to obtain a classification of peristomal bulging based on findings at ultrasonography in patients with a sigmoid colostomy. Methods. The patient material comprised 30 men and 33 women. The median age was 69 years (28–90) and the median time between stoma creation and investigation was 68 months (3–426). Any bulging was measured, and the abdominal opening for the stoma bowel was evaluated at the clinical examination. At the ultrasonographic investigation, the patients were first investigated in the supine position to measure the transverse and vertical diameter of the abdominal opening and the thickness of the abdominal muscles. Results. Three types of ultrasonographic findings were identified. In ultra-I, the stoma bowel was completely fixed or showed telescoping-like movement through the abdominal opening. In ultra-II, fatty tissue was prolapsed together with the stoma bowel forming a bend in the subcutaneous tissue. In ultra-III, another bowel segment or fatty tissue passed beside the stoma bowel through the abdominal opening into the abdominal wall. A normal finding without any bulging at the clinical examination was associated with a smaller area and a smaller diameter of the abdominal opening than the area and diameter in patients with a visible peristomal bulging. There was no difference in the thickness of the muscle layer of the abdominal wall between patients with and without bulging. Conclusions. Ultrasonography can make a dynamic diagnosis of parastomal hernia. In patients with visible peristomal bulging, the area of the abdominal opening is increased but there is no decrease in the thickness of the muscles of the abdominal wall.

A Rare Cause of Parastomal Hernia: Stomach Herniation

Our case of a parastomal hernia is rare because the stomach became incarcerated in the hernial sac. The diagnosis of parastomal hernia is not a difficult one, but one must be aware of the possible complications of the colostomy and the rare occurrence of the parastomal hernia containing the stomach.