Laparoscopic versus open repair of parastomal hernias: an ACS-NSQIP analysis of short-term outcomes
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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.
KeywordsLaparoscopy 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.Turnbull GB (2003) Ostomy statistics: the $64,000 question. Ostomy Wound Manag 49(6):22–23Google Scholar
- 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.American College of Surgeons National Surgical Quality Improvement Program (NSQIP) (2012) User guide for the participant use data file, 2005–2010. http://site.acsnsqip.org/participant-use-data-file/. Accessed 19 Oct 2012
- 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