, Volume 22, Issue 1, pp 183–198 | Cite as

European Hernia Society guidelines on prevention and treatment of parastomal hernias

  • S. A. AntoniouEmail author
  • F. Agresta
  • J. M. Garcia Alamino
  • D. Berger
  • F. Berrevoet
  • H.-T. Brandsma
  • K. Bury
  • J. Conze
  • D. Cuccurullo
  • U. A. Dietz
  • R. H. Fortelny
  • C. Frei-Lanter
  • B. Hansson
  • F. Helgstrand
  • A. Hotouras
  • A. Jänes
  • L. F. Kroese
  • J. R. Lambrecht
  • I. Kyle-Leinhase
  • M. López-Cano
  • L. Maggiori
  • V. Mandalà
  • M. Miserez
  • A. Montgomery
  • S. Morales-Conde
  • M. Prudhomme
  • T. Rautio
  • N. Smart
  • M. Śmietański
  • M. Szczepkowski
  • C. Stabilini
  • F. E. Muysoms



International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project.


The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants.


End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed.


An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.


Parastomal hernia Stoma Ostomy Prevention Treatment Recurrence 



The guidelines development group would like to thank Sarah Squire, representative of the Colostomy Association of the UK, and Wendy Osborne and Judy Hanley, representatives of the Association of Stoma Care Nurses UK, for their valuable input. Dr. William Hope, MD, FACS, Prof. Bruce Ramshaw, MD, FACS and Prof. Willem Bemelman, MD, PhD, are greatly acknowledged for performing the external assessments.


The project ‘European Hernia Society Guidelines on Prevention and Treatment of Parastomal Hernias’ was initiated and sponsored by the European Hernia Society.

Compliance with ethical standards

Conflicts of interest

SAA declares no conflict of interest. FA declares no conflict of interest. JGA declares no conflict of interest. DB declares no conflict of interest. FB declares no conflict of interest. HTB declares no conflict of interest. KB declares no conflict of interest. JC declares conflict of interest not directly related to the submitted work (personal fees from Johnson & Johnson Ethicon, personal fees from BARD Davol). DC declares conflict of interest not directly related to the submitted work (grants and personal fees from W.L. Gore, personal fees from BARD Davol, personal fees from Johnson & Johnson and personal fees from MSD). UAD declares no conflict of interest. RHF declares no conflict of interest. CFL declares no conflict of interest. BH declares no conflict of interest. FH declares no conflict of interest. AH declares no conflict of interest. AJ declares no conflict of interest. LFK declares no conflict of interest. JRL declares no conflict of interest. IKL declares no conflict of interest. MLC declares conflict of interest not directly related to the submitted work (personal fees from Johnson & Johnson and personal fees from BARD Davol). MM declares conflict of interest not directly related to the submitted work (personal fees from Springer, personal fees from Aspide, grants and personal fees from Bard, personal fees from Braun, personal fees from Cook, grants and personal fees from Covidien, personal fees from Ethicon and personal fees from W.L. Gore) and he serves as co-editor of Hernia. AM serves as executive editor of Hernia. SMC declares conflict of interest not directly related to the submitted work (personal fees from Bard, personal fees from Gore, personal fees from Medtronic and personal fees from Olympus). MP declares no conflict of interest. TR declares no conflict of interest. NS declares conflict of interest not directly related to the submitted work (grants and personal fees from Medtronic). MS declares no conflict of interest. MS declares no conflict of interest. CS declares no conflict of interest. FEM declares conflict of interest not directly related to the submitted work (grants, personal fees and non-financial support from Medtronic, grants and personal fees from Johnson & Johnson, grants and personal fees from Dynamesh, personal fees from Cousin Biotech and personal fees from BARD Davol).

Ethical approval

For this type of study formal consent is not required.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

This article does not require informed consent due to the lack of human participants.

Supplementary material

10029_2017_1697_MOESM1_ESM.pdf (840 kb)
Supplementary material 1 (PDF 839 kb)
10029_2017_1697_MOESM2_ESM.pdf (390 kb)
Supplementary material 2 (PDF 390 kb)
10029_2017_1697_MOESM3_ESM.pdf (166 kb)
Supplementary material 3 (PDF 165 kb)
10029_2017_1697_MOESM4_ESM.pdf (335 kb)
Supplementary material 4 (PDF 334 kb)


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Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  • S. A. Antoniou
    • 1
    Email author
  • F. Agresta
    • 2
  • J. M. Garcia Alamino
    • 3
  • D. Berger
    • 4
  • F. Berrevoet
    • 5
  • H.-T. Brandsma
    • 6
  • K. Bury
    • 7
  • J. Conze
    • 8
    • 9
    • 10
  • D. Cuccurullo
    • 11
  • U. A. Dietz
    • 12
  • R. H. Fortelny
    • 13
  • C. Frei-Lanter
    • 14
  • B. Hansson
    • 15
  • F. Helgstrand
    • 16
  • A. Hotouras
    • 17
  • A. Jänes
    • 18
  • L. F. Kroese
    • 19
  • J. R. Lambrecht
    • 20
  • I. Kyle-Leinhase
    • 21
  • M. López-Cano
    • 22
  • L. Maggiori
    • 23
  • V. Mandalà
    • 24
  • M. Miserez
    • 25
  • A. Montgomery
    • 26
  • S. Morales-Conde
    • 27
  • M. Prudhomme
    • 28
  • T. Rautio
    • 29
  • N. Smart
    • 30
  • M. Śmietański
    • 31
    • 32
  • M. Szczepkowski
    • 33
    • 34
  • C. Stabilini
    • 35
  • F. E. Muysoms
    • 21
  1. 1.Department of General SurgeryUniversity Hospital of HerakionCreteGreece
  2. 2.Department of General SurgeryAdriaItaly
  3. 3.Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
  4. 4.Clinic of Abdominal, Thoracic and Pediatric SurgeryKlinikum Mittelbaden/BalgBaden-BadenGermany
  5. 5.Department of General and HPB Surgery and Liver TransplantationGhent University HospitalGhentBelgium
  6. 6.Department of Colorectal SurgeryWestern General HospitalEdinburghUK
  7. 7.Department Cardiac and Vascular SurgeryMedical University of GdańskGdańskPoland
  8. 8.Herniacenter Dr. Muschaweck/Dr. ConzeMunichGermany
  9. 9.Herniacenter Dr. Muschaweck/Dr. ConzeLondonUK
  10. 10.Department of General, Visceral and Transplant SurgeryUniversity Hospital, RWTH Aachen UniversityAachenGermany
  11. 11.Department of General, Laparoscopic, and Robotic SurgeryOspedale Monaldi, Azienda Ospedaliera dei ColliNaplesItaly
  12. 12.Department of General, Visceral, Vascular and Pediatric SurgeryUniversity Hospital of WuerzburgWuerzburgGermany
  13. 13.Certified Hernia Center, Department of General, Visceral and Oncological SurgeryWilhelminenspitalViennaAustria
  14. 14.Department of SurgeryKantonsspital WinterthurWinterthurSwitzerland
  15. 15.Department of SurgeryCanisius-Wilhelmina HospitalNijmegenThe Netherlands
  16. 16.Department of Surgery, Zealand University HospitalKøgeDenmark
  17. 17.National Bowel Research Centre, The Royal London HospitalLondonUnited Kingdom
  18. 18.Department of SurgerySundsvall HospitalSundsvallSweden
  19. 19.Department of SurgeryErasmus University Medical CenterRotterdamNetherlands
  20. 20.Surgical DepartmentInnlandet Hospital TrustGjøvikNorway
  21. 21.Department of SurgeryMaria Middelares HospitalGhentBelgium
  22. 22.Abdominal Wall Surgery Unit, Department of General SurgeryHospital Universitari Vall d’Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
  23. 23.Department of Colorectal SurgeryBeaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VIIClichyFrance
  24. 24.Department of General SurgeryBuccheri La Ferla HospitalPalermoItaly
  25. 25.Department of Abdominal SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  26. 26.Department of SurgerySkåne University HospitalMalmöSweden
  27. 27.University Hospital Virgen del RocíoSevillaSpain
  28. 28.Digestive Surgery DepartmentCHU NîmesNîmesFrance
  29. 29.Department of Surgery, Division of GastroenterologyMedical Research Center, Oulu University HospitalOuluFinland
  30. 30.Exeter Surgical Health Services Research Unit (HeSRU)Royal Devon and Exeter HospitalExeterUK
  31. 31.2nd Department of RadiologyMedical University of GdanskGdańskPoland
  32. 32.Department of General Surgery and Hernia Centre, District Hospital in PuckPuckPoland
  33. 33.Department of RehabilitationJózef Piłsudski University of Physical Education in WarsawWarsawPoland
  34. 34.Clinical Department of General and Colorectal SurgeryBielanski HospitalWarsawPoland
  35. 35.Department of SurgeryUniversity of GenoaGenoaItaly

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