The persistent challenge of parastomal herniation: a review of the literature and future developments

Hotouras, Alexander; Murphy, Jamie; Thaha, Mohamed A.; Chan, Christopher L.

doi:10.1111/codi.12156

Cited by 127 publications

(105 citation statements)

References 105 publications

(164 reference statements)

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“…It is diicult to establish the exact incidence of PSH; however, it has been estimated at 4-48% for colostomies and 2-28% for ileostomies in surgical practice [1,6] (Table 1). This discrepancy is presumably because of the lack of a consistent deinition of PSH, variations in clinical or radiological diagnostic methods (which have yet to be standardized), variations in followup time, and small or heterogeneous patient groups [4,6,[9][10][11].…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

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Parastomal Hernia

Çelik¹,

Kocaay²,

Akyol³

2017

Hernia

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Parastomal hernia (PSH) is a type of incisional hernia deined as a protrusion of abdominal contents through a weakness in the abdominal wall. PSH is the most common and signiicant complication following enterostomy construction, with an incidence of 30-50%. The risk is higher in colostomies than in ileostomies. Diagnosis of PSH is based on clinical examination or imaging. Most patients with PSH are usually asymptomatic. On the other hand, PSHs may afect an individual's physical function and decrease their quality of life. Surgical repair is indicated in 10-30% of patients with PSH. For repair, no single technique is superior to another. Therefore, several surgical methods have been developed and atempted, including primary repair, stoma relocation, and repair with diferent types of mesh either via the open or laparoscopic approach. However, high recurrence rates have been reported after repair. Because this is a diicult and problematic entity, the prevention of PSH occurrence is clearly the most appropriate management approach.

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Section: Incidence and Risk Factorsmentioning

confidence: 99%

“…Ostomy creation and one of its major complications, PSH may negatively afect an individual's physical function and quality of life (QoL) [5]. There is no current consensus on the surgical procedure or optimal technique for stoma formation [1,6]. On the other hand, high recurrence rates have been reported after repair [1,3,7].…”

Section: Introductionmentioning

confidence: 99%

Parastomal Hernia

Çelik¹,

Kocaay²,

Akyol³

2017

Hernia

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“…La opción de keyhole debe realizarse con una malla que tenga polipropileno, no con una laminar, según la clasificación de materiales de Bellón (no PTFE) [1][2][3][4][5][6][7] .…”

Section: Técnicas Laparoscópicas: Opcionesunclassified

“…Supone la reparación del defecto mediante una prótesis preformada con una fenestración y un agujero para dejar pasar el estoma [2][3][4][5][6] . Su principal ventaja es que toda la malla contacta con la pared abdominal posterior, asegurando una buena fibrosis 1.…”

Section: A Técnica Keyholeunclassified

“…Tradicionalmente, la cirugía se ha considerado necesaria entre el 15-70 % de los pacientes, en caso de aparición de dolor, incarceración, obstrucción o problemas en el manejo del estoma. En función de la elevada frecuencia con que se presenta este problema parece que se operan muy pocos pacientes, y posiblemente muchos podrían beneficiarse si ofreciéramos una cirugía programada, en hernias de pequeño tamaño, con una reparación eficaz y poco agresiva mediante abordaje laparoscópico [1][2][3][4] . Las hernias crónicas, de gran tamaño, con pérdida de dominio o con hernia incisional asociada precisan una reconstrucción parietal abierta y auguran habitualmente un mal resultado.…”

Section: Introductionunclassified

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Tratamiento laparoscópico de la hernia paraestomal: indicaciones y manejo en la actualidad

Egea

2017

Rev Hispanoam Hernia

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El tratamiento de la hernia paraestomal es muy controvertido. No existe consenso sobre su manejo médico y quirúrgico. El abordaje laparoscópico es una alternativa, pero todavía no existen datos concluyentes sobre qué técnica es la ideal. El propósito de este estudio es analizar las opciones y principios de la reparación laparoscópica de la hernia paraestomal. Se analiza la necesidad de un seguimiento activo del paciente portador de un estoma y la indicación precoz de cirugía si se confi rma la hernia con una tomografía.

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Contemporary Outcomes of Elective Parastomal Hernia Repair in Older Adults

et al. 2023

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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.

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The persistent challenge of parastomal herniation: a review of the literature and future developments

Cited by 127 publications

References 105 publications

Parastomal Hernia

Parastomal Hernia

Tratamiento laparoscópico de la hernia paraestomal: indicaciones y manejo en la actualidad

Contemporary Outcomes of Elective Parastomal Hernia Repair in Older Adults

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