Surgical repair of parastomal bulging: a retrospective register‐based study on prospectively collected data

Abstract

Aim The aim of this work was to examine (1) the incidence of primary repair, (2) the incidence of recurrent repair and (3) the types of repair performed in patients with parastomal bulging. Method Prospectively collected data on parastomal bulging from the Danish Stoma Database were linked to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair. Results In the study sample of 1016 patients with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% [95% CI (8%; 11%)] within 1 year and 19% [95% CI (17%; 22%)] within 5 years after the occurrence of a parastomal bulge. We found a similar probability of undergoing primary repair in patients with ileostomy and colostomy. For recurrent repair, the 5-year cumulative incidence was 5% [95% CI (3%; 7%)]. In patients undergoing repair, the probability was 33% [95% CI (21%; 46%)] of having a recurrence requiring repair within 5 years. The main primary repair was open or laparoscopic repair with mesh (43%) followed by stoma revision (39%). Stoma revision and repair with mesh could precede or follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients. Conclusion Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. Having undergone a primary repair, the probability of recurrent repair was high. Stoma reversal was more common than expected.

A semi‐Markov model comparing the lifetime cost‐effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing end colostomy creation for rectal cancer

“…Some patients required surgical repair of their PSH and consequently moved into the "Repair" health state. After the primary PSH repair, some patients had repeat PSH repair(s) due to recurrence and moved into the "Repeat repairs" health state-patients were assumed to have a maximum of four PSH repairs [16]. Patients in any health state could die; the risk of death was assumed to be dependent on age and rectal cancer stage.…”

“…Patients undergoing colostomy for rectal cancer surgery to the occurrence of PSH was 6 months in patients with colostomy [16]. Given that a PSH can occur up to 30 years after stoma creation [5], we ran our model over the lifetime of patients.…”

“…The proportion of patients requiring surgical repair of PSH varies depending on whether a patient has a mesh placed or not during the initial stoma creation. Using the competing risks formula [41], the cycle-specific baseline risk of primary PSH repair was estimated based on the incidence rates of 9% at 1-year and 19% at 5-year reported in a retrospective register-based study on 1,016 patients with a permanent stoma [16]. The relative risk of primary PSH repair for mesh compared with no mesh was derived from a random-effects meta-analysis of 10 RCTs including 336 patients (Table 1; Figure S3 in Appendix S1).…”

“…PSH can also cause serious problems such as bowel obstruction or strangulation which may require emergency treatment in hospital [6,15]. Registry data from Denmark has demonstrated that, regardless of the underlying intestinal disease that led to stoma creation, the development of "bulging" (a composite of true PSH and subdermal prolapse of the afferent stoma limb) immediately adjacent to a stoma is common [16] and up to one third of patients with parastomal bulging undergo surgery to treat it. Recurrence of parastomal bulging is a significant problem and a third of patients who have had surgical repair will go on to have further surgery [16].…”

Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report

“…Repair with a prosthetic mesh can significantly reduce the post-operative recurrence rate. However, there are many mesh-related complications such as intestinal fistula caused by mesh erosion and intestinal obstruction resulting from adhesion of the mesh to the intestine (8)(9)(10). A laparoscopic approach (e.g., sugarbaker, keyhole, or sandwich procedures) combined with mesh repair has gained popularity in recent years for the treatment of parastomal hernia (10).…”