Parastomal Hernia Repair; Seldom Performed and Seldom Reported: Results From a Nationwide Survey

Abstract

Background: Parastomal hernia is common, but there are few population-based studies showing the frequency and outcome of parastomal hernia repair in routine surgical practice. The aim of this study was to identify patients undergoing surgery for parastomal hernia in Sweden and to define risk factors for complication and recurrence. Methods: A broad search of the Swedish National Patient Register 1998–2007 for all possible parastomal hernia repairs using surgical procedure codes. Records of all patients identified were reviewed and those with a definite parastomal hernia procedure were included and analyzed. Results: A total of 71 patients were identified after review of the records. The most common reason for surgery was cosmetic and the most frequent method was relocation of the stoma. Parastomal hernia recurrence rate was 18% during follow-up of a minimum 2 years. Overall, a surgical complication occurred in 32%. Possible risk factors were analyzed including emergency surgery versus planned, gender, age, indication for surgery, and method of surgery; none of which was significant. Conclusion: The frequency of parastomal hernia procedures was much lower than suggested by previous studies. The number of procedures per surgeon was even lower than expected. No specific risk factor could be identified. Parastomal hernia auditing in the form of a nationwide quality register should be mandatory. Centralization should be considered.

Stoma‐related complications: a report from the Stoma‐Const randomized controlled trial

“…The avoidance of a parastomal hernia by the placement of a prophylactic mesh has been studied extensively [20–25]. However, our recent randomized trial Stoma‐Const [26] could not identify a preferred method for stoma construction in order to prevent parastomal hernia [27] which was also true for another recent trial [28].…”

Surgical treatment of stoma-related hernias: retrospective cohort study of damage claims to the Swedish National Patient Insurance Company 2010–2016

“…The low absolute number of observations must be viewed in relation to the overall frequency of stoma-related hernia surgery in Sweden, especially PSH surgery as reported by Odensten [ 12 ]. In that study, a mandatory national inpatient register with 99% coverage was searched for diagnosis and procedure codes over a nine-year period.…”

“…In a recent nationwide population-based study by our group using a national inpatient register with 99% coverage and scrutinization of the corresponding medical records, the incidence of PSH surgery in Sweden was found to be 71 cases over a nine-year period, extrapolating to 10.5 cases per year when considering missing data [ 12 ].…”

Hernia and Cancer: The Points Where the Roads Intersect

“…Herniation through the stoma site, the entity named parastomal hernia, is not rare (141, 142). Its treatment is also challenging (143). These issues will be addressed as specific topics in separate parts of this review.…”