Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland

,

doi:10.1111/codi.14249

Cited by 32 publications

(3 citation statements)

References 101 publications

(125 reference statements)

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“…However, only 24% of patients with an ostomy remain asymptomatic in the long term [5]. Subsequently, the Association of Coloproctology of Great Britain and Ireland identified that the prevention and treatment of PSHs are the second most important non-cancer-related issues due to high recurrence rates after hernia repair [6]. Although prophylactic mesh for PSH prevention has been advocated [7][8][9] a recent randomized controlled trial has shown that reinforcing meshes to prevent PSH formation cannot be recommended [10].…”

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confidence: 99%

High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study

et al. 2021

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Aim: This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction. Method:We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up.Results: Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m 2 (range 25-47). Twelve patients had an expected associated risk according to the Carolinas equation for determining associated risk classification of >60%. Sixty per cent of our patients had contaminated or dirty/infected wounds. The overall complication rate was 60%. Surgical site infection was observed in 25% of the cases. The mortality rate in our study group was 5% (n = 1). We found clinical or radiological evidence of parastomal hernia recurrence in nine out of 20 (45%) patients during follow-up. No hernia recurrence was detected in the concomitant incisional hernias. Conclusions:Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.

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Section: Introductionmentioning

confidence: 99%

High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study

et al. 2021

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“…The proportion of stoma patients who develop a PSH varies widely in the published literature due to heterogeneity in the definition and mode of diagnosis. Both the EHS and the Association of Coloproctology of Great Britain and Ireland guidelines suggest a range of 5%-50% [5,6]. However, a 2018 systematic review of stoma-related morbidity in randomized trials reported a range of 41.5%-88.2% in patients with an end colostomy [7], which reflects findings from a randomized controlled trial on the use of prophylactic mesh in permanent colostomy formation which reported that 93.8% of the patients in the control group developed a PSH [8].…”

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confidence: 99%

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

2024

Colorectal Disease

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AimA significant proportion of stoma patients develop a parastomal hernia (PSH), with reported rates varying widely from 5% to 50% due to heterogeneity in the definition and mode of diagnosis. PSHs are symptomatic in 75% of these patients, causing a significant impact on quality of life due to issues with appliance fitting, leakage, skin excoriation and pain. They can also lead to emergency presentations with strangulation and obstruction. Evidence is lacking on how to select patients for surgical intervention or conservative treatment. In those who do undergo surgery, the best operation for a particular patient or PSH is not always clear and many options exist. The aim of this study is to assess the impact of an individual patient’s PSH treatment on their subsequent self‐reported outcomes including treatment success and quality of life.MethodsThis is a prospective international cohort study of PSH treatment, including both operative and non‐operative interventions. A global network of clinicians and specialist nurses will recruit 1000–1500 patients and centralize detailed information, their individual background and their PSH treatment, as well as short‐term outcomes up to 30 days. Patients will then provide their own outcomes data including quality of life and whether their treatment was successful, via a secure online system, at 3, 6 and 12 months. PROPHER will be run in two phases: an internal pilot phase of at least 10 hospitals from up to five countries, and a main phase of up to 200 hospitals from across the European Society of Coloproctology network.DiscussionThis study will provide a wealth of contemporaneous information which will improve our ability to counsel patients and facilitate improved selection of appropriate and personalized interventions for those with a PSH.

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“…Although prophylactic mesh may delay the onset of parastomal hernia in patients with an end colostomy [13][14][15][16], the application of prophylactic meshes in clinical practice is low [17]. For non-surgical preventive interventions, for example physical or abdominal training, lifting restrictions or wearing support garments, there is no firm evidence [18]. Surgical treatment of parastomal bulging is technically challenging with significant morbidity and recurrence [19][20][21][22].…”

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confidence: 99%

Understanding patients' perspectives when unprepared for the emergence of a parastomal bulge—a qualitative study

Krogsgaard,

Dreyer,

Thomsen

2023

Colorectal Disease

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AimThe aim was to investigate patients' experiences of being prepared for the development of a parastomal bulge in relation to a stoma.MethodsThe paper draws on a qualitative interview study conducted with 20 Danish patients participating in five focus groups. Analysis was performed using a phenomenological‐hermeneutic approach.ResultsWe identified three themes. The first theme is ‘The unforeseen bulge gives rise to increasing concern and a search for an explanation’. Patients searched for explanations in their own life and suspected that their behaviour or previous illness induced the bulge. The second theme is ‘Missing or confusing information leads to counterproductive behaviour’. Patients lacked information on the prevention and treatment of parastomal bulging which led to disappointment with healthcare professionals. The third theme is ‘Weighing the pros and cons of life with the bulge against the gamble of surgical repair’. Some patients came to terms with their situation, but for others a deadlocked situation arose when surgical repair was not an option.ConclusionHealthcare communication directly impacts on patients' experiences and outcomes. When unprepared for the emergence of a parastomal bulge, patients' emotional and psychological well‐being are affected and likewise patients' possibility of using their own health beliefs as a preventive strategy. To preserve patient autonomy, satisfaction and well‐being, surgeons and stoma nurses should provide patients with tailored information bearing in mind the current lack of clear evidence on the prevention and treatment of parastomal bulging.

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Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland

Cited by 32 publications

References 101 publications

High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study

High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study

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

Understanding patients' perspectives when unprepared for the emergence of a parastomal bulge—a qualitative study

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