Contemporary Outcomes of Elective Parastomal Hernia Repair in Older Adults

Abstract

ImportanceParastomal hernia is a challenging complication following ostomy creation; however, the incidence and long-term outcomes after elective parastomal hernia repair are poorly characterized.ObjectiveTo describe the incidence and long-term outcomes after elective parastomal hernia repair.Design, Setting, and ParticipantsUsing 100% Medicare claims, a retrospective cohort study of adult patients who underwent elective parastomal hernia repair between January 1, 2007, and December 31, 2015, was performed. Logistic regression and Cox proportional hazards models were used to evaluate mortality, complications, readmission, and reoperation after surgery. Analysis took place between February and May 2022.ExposuresParastomal hernia repair without ostomy resiting, parastomal hernia repair with ostomy resiting, and parastomal hernia repair with ostomy reversal.Main Outcomes and MeasuresMortality, complications, and readmission within 30 days of surgery and reoperation for recurrence (parastomal or incisional hernia repair) up to 5 years after surgery.ResultsA total of 17 625 patients underwent elective parastomal hernia repair (mean [SD] age, 73.3 [9.1] years; 10 059 female individuals [57.1%]). Overall, 7315 patients (41.5%) underwent parastomal hernia repair without ostomy resiting, 2744 (15.6%) underwent parastomal hernia repair with ostomy resiting, and 7566 (42.9%) underwent parastomal hernia repair with ostomy reversal. In the 30 days after surgery, 676 patients (3.8%) died, 7088 (40.2%) had a complication, and 1740 (9.9%) were readmitted. The overall adjusted 5-year cumulative incidence of reoperation was 21.1% and was highest for patients who underwent parastomal hernia repair with ostomy resiting (25.3% [95% CI, 25.2%-25.4%]) compared with patients who underwent parastomal hernia repair with ostomy reversal (18.8% [95% CI, 18.7%-18.8%]). Among patients whose ostomy was not reversed, the hazard of repeat parastomal hernia repair was the same for patients whose ostomy was resited vs those whose ostomy was not resited (adjusted hazard ratio, 0.93 [95% CI, 0.81-1.06]).Conclusions and RelevanceIn this study, more than 1 in 5 patients underwent another parastomal or incisional hernia repair within 5 years of surgery. Although this was lowest for patients who underwent ostomy reversal at their index operation, ostomy resiting was not superior to local repair. Understanding the long-term outcomes of this common elective operation may help inform decision-making between patients and surgeons regarding appropriate operative approach and timing of surgery.

The PROPHER study: patient‐reported outcomes after parastomal hernia treatment—a prospective international cohort study

“…We know that recurrence rates from PSH repairs are high, even in centres with a dedicated interest in PSH [14, 28]. This study will enable us to collect data on the operative techniques employed, including mesh usage, type, plane of placement and other technical factors, along with patient‐reported outcomes which will allow us to explore potential associations between operative techniques and patient‐reported outcomes including success rates, reintervention rates and QoL.…”

“…Up to one‐third of patients with a PSH will undergo a repair at some point and, of these, up to a third will undergo recurrent repairs [13]. A recently published retrospective cohort study from the USA found that 40.2% of patients had a complication from their PSH repair, with a cumulative 5‐year incidence of reoperation of 21.1% [14]. This reflects data from the Danish Registry which found a probability of 33% of recurrence requiring further surgery within 5 years [15].…”

Challenges and Strategies in Colorectal Surgery among Patients with Morbid Obesity

“…For patients with a temporary ostomy who will become eligible for reversal, obesity is associated with both short-term complications as well as long-term hernia recurrence following parastomal hernia repair and ostomy reversal. 37,38 Again, insofar as patients can undergo ostomy takedown electively, it may be reasonable to consider referral for bariatric surgery preemptively to reduce the risk of postoperative complications and hernia recurrence.…”

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

“…Surgeons do not know the best way to repair a PSH, nor do they know whether watchful waiting is safe or whether it can result in more complications [2]. Additionally, recurrence risks from PSH repair are high [3,4].…”