Surgical Endoscopy

, Volume 27, Issue 11, pp 4067–4072

Laparoscopic versus open repair of parastomal hernias: an ACS-NSQIP analysis of short-term outcomes

Authors

  • Wissam J. Halabi
    • Department of SurgeryUniversity of California- Irvine
  • Mehraneh D. Jafari
    • Department of SurgeryUniversity of California- Irvine
  • Joseph C. Carmichael
    • Department of SurgeryUniversity of California- Irvine
  • Vinh Q. Nguyen
    • Department of StatisticsUniversity of California Irvine
  • Steven Mills
    • Department of SurgeryUniversity of California- Irvine
  • Michael Phelan
    • Department of StatisticsUniversity of California Irvine
  • Michael J. Stamos
    • Department of SurgeryUniversity of California- Irvine
    • Department of SurgeryUniversity of California- Irvine
Article

DOI: 10.1007/s00464-013-3062-9

Cite this article as:
Halabi, W.J., Jafari, M.D., Carmichael, J.C. et al. Surg Endosc (2013) 27: 4067. doi:10.1007/s00464-013-3062-9

Abstract

Background

Parastomal hernia (PSH) is a frequent complication following the creation of a stoma. While a significant number of cases require operative management, data comparing short-term outcomes of laparoscopic versus open repair of parastomal hernias are limited.

Methods

The ACS-NSQIP was retrospectively reviewed from 2005 to 2011 for all PSH cases that underwent open or laparoscopic repair. Patients characteristics, operative details, and outcomes were listed for both procedure types. Selected end points were compared on multivariate regression analysis.

Results

Among the 2,167 identified parastomal hernia cases, only 222 (10.24 %) were treated laparoscopically. The open and laparoscopic groups were similar with respect to mean patient age (63 vs. 63 years; p = 1) and gender distribution as the majority of patients were females (56.8 %). However, open repair was more likely to be performed in patients with a higher ASA class (III and IV) (p < 0.001). Also, the open approach was more likely to be used emergently (8.64 vs. 3.60 %; p = 0.01) and for recurrent hernias (6.99 vs. 3.15 %; p < 0.05). After adjusting for all potential confounders including age, gender, ASA, emergency designation of the operation, hernia type, and wound class, laparoscopy was associated with shorter operative time (137.5 vs. 153.4 min; p < 0.05), shorter length of hospital stay by 3.32 days (p < 0.001), lower risk of overall morbidity (OR = 0.42; p < 0.001), and a lower risk of surgical site infections (OR = 0.35; p < 0.01) compared to open repair. Mortality rates were similar in the laparoscopic and open groups (0.45 vs. 1.59 %, respectively; p = 0.29).

Conclusions

Laparoscopic parastomal hernia repair is safe and appears to be associated with better short-term outcomes compared to open repair in selected cases. Large prospective randomized trials are needed to confirm those results and to assess long-term recurrence rates.

Keywords

LaparoscopyParastomalPeristomalHerniaColorectalStomaOstomyShort-term outcomesNSQIP

Copyright information

© Springer Science+Business Media New York 2013