Surgical Endoscopy

, Volume 27, Issue 11, pp 4067–4072 | Cite as

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

  • Wissam J. Halabi
  • Mehraneh D. Jafari
  • Joseph C. Carmichael
  • Vinh Q. Nguyen
  • Steven Mills
  • Michael Phelan
  • Michael J. Stamos
  • Alessio PigazziEmail author



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.


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.


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).


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.


Laparoscopy Parastomal Peristomal Hernia Colorectal Stoma Ostomy Short-term outcomes NSQIP 



The Department of Statistics at UC Irvine, with which V. Nguyen and M. Phelan are affiliated, was paid a statistical consulting fee by the Department of Surgery at UC Irvine. The Department of Surgery at UC Irvine, with which S. Mills is affiliated, was paid an educational grant from Ethicon. Ethicon, Covidien, Olympus, Adolor, and NiTi gave educational grants and speaker fees to the Department of Surgery at UC Irvine, with which M. Stamos is affiliated. Intuitive Surgical paid consultancy and educational grants to the Department of Surgery at UC Irvine, with which A. Pigazzi is affiliated.


  1. 1.
    Turnbull GB (2003) Ostomy statistics: the $64,000 question. Ostomy Wound Manag 49(6):22–23Google Scholar
  2. 2.
    Brown H, Randle J (2005) Living with a stoma: a review of the literature. J Clin Nurs 14(1):74–81PubMedCrossRefGoogle Scholar
  3. 3.
    Persson E, Berndtsson I, Carlsson E, Hallen AM, Lindholm E (2010) Stoma-related complications and stoma size: a 2-year follow up. Colorectal Dis 12(10):971–976PubMedCrossRefGoogle Scholar
  4. 4.
    Mahjoubi B, Moghimi A, Mirzaei R, Bijari A (2005) Evaluation of the end colostomy complications and the risk factors influencing them in Iranian patients. Colorectal Dis 7(6):582–587PubMedCrossRefGoogle Scholar
  5. 5.
    Neuman HB, Park J, Fuzesi S, Temple LK (2012) Rectal cancer patients’ quality of life with a temporary stoma: shifting perspectives. Dis Colon Rectum 55(11):1117–1124PubMedCrossRefGoogle Scholar
  6. 6.
    Kald A, Juul KN, Hjortsvang H, Sjodahl RI (2008) Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 43(5):627–633PubMedCrossRefGoogle Scholar
  7. 7.
    Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M (2011) Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 148(6):e435–e441PubMedCrossRefGoogle Scholar
  8. 8.
    Hansson BM, Slater NJ, van der Velden AS et al (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255(4):685–695PubMedCrossRefGoogle Scholar
  9. 9.
    Israelsson LA (2005) Preventing and treating parastomal hernia. World J Surg 29(8):1086–1089PubMedCrossRefGoogle Scholar
  10. 10.
    Hotouras A, Murphy J, Thaha M, Chan C (2013) The persistent challenge of parastomal herniation: a review of the literature and future developments. Colorectal Dis 15(5):e202–e214PubMedCrossRefGoogle Scholar
  11. 11.
    Asif A, Ruiz M, Yetasook A et al (2012) Laparoscopic modified Sugarbaker technique results in superior recurrence rate. Surg Endosc 26(12):3430–3434PubMedCrossRefGoogle Scholar
  12. 12.
    Craft RO, Huguet KL, McLemore EC, Harold KL (2008) Laparoscopic parastomal hernia repair. Hernia 12(2):137–140PubMedCrossRefGoogle Scholar
  13. 13.
    Hansson BM, Bleichrodt RP, de Hingh IH (2009) Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate. Surg Endosc 23(7):1456–1459PubMedCrossRefGoogle Scholar
  14. 14.
    Hansson BM, de Hingh IH, Bleichrodt RP (2007) Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients. Surg Endosc 21(6):989–993PubMedCrossRefGoogle Scholar
  15. 15.
    Hansson BM, Morales-Conde S, Mussack T, Valdes J, Muysoms FE, Bleichrodt RP (2013) The laparoscopic modified Sugarbaker technique is safe and has a low recurrence rate: a multicenter cohort study. Surg Endosc 27(2):494–500PubMedCrossRefGoogle Scholar
  16. 16.
    Mancini GJ, McClusky DA 3rd, Khaitan L et al (2007) Laparoscopic parastomal hernia repair using a nonslit mesh technique. Surg Endosc 21(9):1487–1491PubMedCrossRefGoogle Scholar
  17. 17.
    Mizrahi H, Bhattacharya P, Parker MC (2012) Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results. Surg Endosc 26(1):267–270PubMedCrossRefGoogle Scholar
  18. 18.
    Muysoms F (2007) Laparoscopic repair of parastomal hernias with a modified Sugarbaker technique. Acta Chir Belg 107(4):476–480PubMedGoogle Scholar
  19. 19.
    Safadi B (2004) Laparoscopic repair of parastomal hernias: early results. Surg Endosc 18(4):676–680PubMedCrossRefGoogle Scholar
  20. 20.
    Wara P, Andersen LM (2011) Long-term follow-up of laparoscopic repair of parastomal hernia using a bilayer mesh with a slit. Surg Endosc 25(2):526–530PubMedCrossRefGoogle Scholar
  21. 21.
    Steele SR, Lee P, Martin MJ, Mullenix PS, Sullivan ES (2003) Is parastomal hernia repair with polypropylene mesh safe? Am J Surg 185(5):436–440PubMedCrossRefGoogle Scholar
  22. 22.
    Guzman-Valdivia G, Guerrero TS, Laurrabaquio HV (2008) Parastomal hernia-repair using mesh and an open technique. World J Surg 32(3):465–470PubMedCrossRefGoogle Scholar
  23. 23.
    Longman RJ, Thomson WH (2005) Mesh repair of parastomal hernias: a safety modification. Colorectal Dis 7(3):292–294PubMedCrossRefGoogle Scholar
  24. 24.
    Stelzner S, Hellmich G, Ludwig K (2004) Repair of paracolostomy hernias with a prosthetic mesh in the intraperitoneal onlay position: modified Sugarbaker technique. Dis Colon Rectum 47(2):185–191PubMedCrossRefGoogle Scholar
  25. 25.
    van Sprundel TC, van der Hoop AG (2005) Modified technique for parastomal hernia repair in patients with intractable stoma-care problems. Colorectal Dis 7(5):445–449PubMedCrossRefGoogle Scholar
  26. 26.
    Pastor DM, Pauli EM, Koltun WA, Haluck RS, Shope TR, Poritz LS (2009) Parastomal hernia repair: a single center experience. J Soc Laparoendosc Surg 13(2):170–175Google Scholar
  27. 27.
    American College of Surgeons National Surgical Quality Improvement Program (NSQIP) (2012) User guide for the participant use data file, 2005–2010. Accessed 19 Oct 2012
  28. 28.
    Simorov A, Shaligram A, Shostrom V, Boilesen E, Thompson J, Oleynikov D (2012) Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers. Ann Surg 256(3):462–468PubMedCrossRefGoogle Scholar
  29. 29.
    Kang CY, Halabi WJ, Luo R, Pigazzi A, Nguyen NT, Stamos MJ (2012) Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg 147(8):724–731PubMedCrossRefGoogle Scholar
  30. 30.
    Berger D, Bientzle M (2007) Laparoscopic repair of parastomal hernias: a single surgeon’s experience in 66 patients. Dis Colon Rectum 50(10):1668–1673PubMedCrossRefGoogle Scholar
  31. 31.
    Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781Google Scholar
  32. 32.
    LeBlanc KA, Bellanger DE, Whitaker JM, Hausmann MG (2005) Laparoscopic parastomal hernia repair. Hernia 9(2):140–144PubMedCrossRefGoogle Scholar
  33. 33.
    Veenhof AA, Vlug MS, van der Pas MH et al (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255(2):216–221PubMedCrossRefGoogle Scholar
  34. 34.
    Hemandas AK, Abdelrahman T, Flashman KG et al (2010) Laparoscopic colorectal surgery produces better outcomes for high risk cancer patients compared to open surgery. Ann Surg 252(1):84–89PubMedCrossRefGoogle Scholar
  35. 35.
    Kang CY, Halabi WJ, Chaudhry OO et al (2013) A nationwide analysis of laparoscopy in high-risk colorectal surgery patients. J Gastrointest Surg 17(2):382–391PubMedCrossRefGoogle Scholar
  36. 36.
    Pilgrim CH, McIntyre R, Bailey M (2010) Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum 53(1):71–76PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Wissam J. Halabi
    • 1
  • Mehraneh D. Jafari
    • 1
  • Joseph C. Carmichael
    • 1
  • Vinh Q. Nguyen
    • 2
  • Steven Mills
    • 1
  • Michael Phelan
    • 2
  • Michael J. Stamos
    • 1
  • Alessio Pigazzi
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of California- IrvineOrangeUSA
  2. 2.Department of StatisticsUniversity of California IrvineIrvineUSA

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