European Hernia Society classification of parastomal hernias

Abstract

Purpose A classification of parastomal hernias (PH) is needed to compare different populations described in various trials and cohort studies, complete the previous inguinal and ventral hernia classifications of the European Hernia Society (EHS) and will be integrated into the EuraHS database (European Registry of Abdominal Wall Hernias).MethodsSeveral members of the EHS board and invited experts gathered for 2 days to discuss the development of an EHS classification of PH. The discussions were based on a literature review and critical appraisal of existing classifications.ResultsThe classification proposal is based on the PH defect size (small is ≤5 cm) and the presence of a concomitant incisional hernia (cIH). Four types were defined: Type I, small PH without cIH; Type II, small PH with cIH; Type III, large PH without cIH; and Type IV, large PH with cIH. In addition, the classification grid includes details about whether the hernia recurs after a previous PH repair or whether it is a primary PH. Clinical validation is needed in the future to assess if the classification allows us to differentiate the treatment strategy and if the classification impacts outcome in these different subgroups.ConclusionA classification of PH divided into subgroups according to size and cIH was formulated with the aim of improving the ability to compare different studies and their results.

Incisional hernia: preliminary observations at a new institute

“…2 To avoid confusion, parastomal hernias were excluded from this classication, and were classified separately. 3 Incisional hernia account for almost 80% of the ventral hernias. 4 Their incidence following laparotomy ranges from 2% to 11% in different studies.…”

Parastomal Hernia

“…Although these classiication systems may be useful in academic research, there is litle requirement for them in clinical practice because assessment, management, and diagnosis are usually based on symptoms and clinical examination. More recently, the European Hernia Society assembled to review the existing classiication systems and expanded upon the deinitions proposed by Gil and Szczepkowski to include a size cutof of 5 cm; however, this new system has not yet been validated as a clinical tool [8,18,19,[21][22][23][24].…”

Actualización de las hernias paraestomales: diagnóstico, tratamiento y prevención

“…La mayoría de las HP aparecen a los 2 años de la cirugía 6 , pero pueden retrasarse hasta 20 o 30 años 9 . No hay que confundir la HP con complicaciones locales del estoma sin saco herniario, como el prolapso mucoso o el siphon loop (recodo del exceso de longitud del estoma en el tejido subcutáneo) 14 .…”

“…Los grupos de Devlin et al 29 y Rubin et al 31 describen cuatro subgrupos de HP en base a los hallazgos intraoperatorios. Estas dos clasificaciones son complejas 10 , difíciles de aplicar preoperatoriamente, e incluyen subgrupos que no cumplen la definición de hernia 14 . En 2009, Moreno-Matías y Serra-Aracil et al 10 propusieron una clasificación clínico-radiológica para las colostomías terminales, aplicable preoperatoriamente, que cataloga las HP en cuatro grupos en función del contenido del saco herniario y la relación del saco y el intestino que forma el estoma, realizando un tac en reposo.…”

“…La clasificación de Gil y Szczepkowski 32 , basada en la exploración física, es sencilla de utilizar preoperatoriamente, pero no define con precisión los puntos de corte de «grande» y «pequeño», lo que puede llevar a errores y dificultar la realización de estudios comparativos 14 . En 2014, la EHS 14 propuso una clasificación integrada en la base de datos EuraHS (European Registry of Abdominal Wall Hernias) con el fin de conseguir un lenguaje común.…”