Parastomal hernia repair with onlay mesh remains a safe and effective approach
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Parastomal hernia repair with onlay mesh remains a safe and effective approach Marie Shella De Robles1* and Christopher J. Young1,2
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. Keywords: Parastomal hernia, Mesh repair, Peristomal incision, Stoma relocation Background Parastomal hernia (PSH) is a common complication of stoma formation in colorectal surgery, with an incidence up to 50% [1–3]. The risk of PSH is highest within the first few years after the formation of the stoma but may develop more than 40 years later. The incidence of PSH depends upon the length of follow-up and diagnostic criteria used—clinical, radiological or intraoperative findings. The lack of a standard definition along with minimal
*Correspondence: [email protected] 1 Department of Colorectal Surgery, Royal Prince Alfred Hospital Medical Centre, Suite G07/100 Carillon Avenue, Newtown, Sydney, NSW 2042, Australia Full list of author information is available at the end of the article
physical exam findings observed with some PSH occurrences make the actual incidence difficult to ascertain. PSH rates may increase with prolonged follow-up. Identified risk factors for PSH include advanced age, obesity, immunosuppression, increased intraabdominal pressure and post-operative wound infection [4]. PSHs are often asymptomatic and can be managed with conservative treatment. However, 11–70% of patients undergo surgery due to increasing hernia size, problems with the stoma
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