Outcome of parastomal hernia repair with and without midline laparotomy

Abstract

PSH repair with relocation without laparotomy was associated with a significantly shorter hospital stay, possibly due to the lack of a midline abdominal wound. It may not be feasible in patients with significant intraabdominal adhesions.

Parastomal Hernia Is a Problem Yet to Be Solved

“…The hernia recurrence rate in this type of repair is lower in comparison to primary fascial repair, but the complication rate is higher along with significantly longer hospitalization. This approach can be difficult in patients with co-morbidities of intra-abdominal adhesions [28]. Although the use of mesh for abdominal wall incisional hernia repair has been known for years, surgeons have tended to avoid using it for repair of PH due to fear of infection.…”

Repair of complex parastomal hernias

“…Primary local fascial repair is technically simple but has a significant recurrence rate (46-100 %) and is not a generally acceptable treatment method for elective repair [4,8,[10][11][12]. Although it was the technique of choice historically, primary fascial repair alone is no longer recommended, especially for complicated PH.…”

“…Many earlier studies recommend stoma relocation, which is purportedly associated with lower recurrence rates (24-86 %) [1,6,8,11,12]. However, this method is associated with a high rate of complications (37-88 %), and introduces the risk of incisional hernia at the original stoma site [6,[11][12][13].…”

“…However, this method is associated with a high rate of complications (37-88 %), and introduces the risk of incisional hernia at the original stoma site [6,[11][12][13]. The risk of recurrent PH at the new site is also at least as high as after primary stoma placement.…”

“…Moreover, this method may require a laparotomy, which may further increase the risk of incisional/parastomal hernia (68 %) [6], overall morbidity and prolonged hospital stay [14]. Several studies show stoma relocation with laparotomy is associated with higher recurrence and morbidity than without laparotomy (9.1 vs. 18.8 %) [8,12,15]. Stoma relocation to the opposite side of the abdomen is associated with lower recurrence (38 vs. 80 %) in a longterm study [15].…”