Techniques in Coloproctology

, Volume 18, Issue 5, pp 427–432 | Cite as

Systematic review of open techniques for parastomal hernia repair

  • J. Al ShakarchiEmail author
  • J. G. Williams


Parastomal hernia formation is common following formation of an abdominal stoma, with the risk of subsequent incarceration, obstruction and strangulation. Current treatment options include non-operative management, stoma relocation and fascial repair with or without mesh. The purpose of this systematic review was to evaluate the effectiveness and safety of open mesh repair of a parastomal hernia and to compare open non-mesh fascial repair with mesh techniques of parastomal hernia repair. Electronic databases were searched for studies comparing the two surgical techniques in accordance with preferred reporting items for systematic reviews and meta-analyses. The primary outcome of the study was the comparison of recurrence rates of parastomal hernia for each technique. Secondary outcomes included comparison of mortality, wound infection, mesh infection and any other complication. Twenty-seven studies of parastomal hernia repair were included and divided into two subgroups for open mesh repair and non-mesh fascial repair. Non-mesh fascial repair resulted in a high recurrence rate (around 50 %). Reported recurrence rates for mesh repair were substantially lower, at 7.9–14.8 %, depending on the position of the mesh in relation to the abdominal fascia and the length of follow-up. Morbidity and mortality did not differ significantly between the techniques used to repair a parastomal hernia. This study shows that mesh repair of a parastomal hernia is safe and significantly reduces the rate of recurrence compared with sutured repair, which should only be used in exceptional circumstances. There is insufficient evidence to determine which mesh technique (onlay, sublay or underlay) is most successful in terms of recurrence rates and morbidity.


Parastomal Hernia Repair Mesh 


Conflict of interest



  1. 1.
    Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793PubMedCrossRefGoogle Scholar
  2. 2.
    Thompson MJ, Trainor B (2005) Incidence of parastomal hernia before and after a prevention programme. Gastrointest Nurs 3:23–27Google Scholar
  3. 3.
    Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the prisma statement. PLoS Med 6:e1000097PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Clopper CJ, Pearson ES (1934) The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 26:404–413CrossRefGoogle Scholar
  5. 5.
    Rubin MS, Schoetz DJ, Matthews JB (1994) Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 129:413–419PubMedCrossRefGoogle Scholar
  6. 6.
    Cheung MT, Chia NH, Chiu WY (2001) Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 44:266–270PubMedCrossRefGoogle Scholar
  7. 7.
    Rieger N, Moore J, Hewett P, Lee S, Stephens J (2004) Parastomal hernia repair. Colorectal Dis 6:203–205PubMedCrossRefGoogle Scholar
  8. 8.
    Riansuwan W, Hull TL, Millan MM et al (2010) Surgery of recurrent parastomal hernia: direct repair or relocation? Colorectal Dis 12:681–686PubMedCrossRefGoogle Scholar
  9. 9.
    Pastor DM, Pauli EM, Koltun WA et al (2009) Parastomal hernia repair: a single center experience. JSLS 13:170–175PubMedCentralPubMedGoogle Scholar
  10. 10.
    Heo SC, Oh KH, Song YS et al (2011) Surgical treatment of a parastomal hernia. J Korean Soc Coloproctol 27:174–179PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    McLemore EC, Harold KL, Efron JE et al (2007) Parastomal Hernia: short term outcome after laparoscopic and conventional repairs. Surg Innov 14:199PubMedCrossRefGoogle Scholar
  12. 12.
    Ho KMT, Fawcett DP (2004) Parastomal hernia repair using the lateral approach. BJU Int 94:598–602PubMedCrossRefGoogle Scholar
  13. 13.
    De Ruiter P, Bijnen AB (2005) Ring-reinforced prosthesis for paracolostomy hernia. Dig Surg 22:152–156PubMedCrossRefGoogle Scholar
  14. 14.
    Steele SR, Lee P, Martin MJ, Mullenix PJ, Sullivan ES (2003) Is parastomal hernia repair with polypropylene mesh safe? Am J Surg 185:436–440PubMedCrossRefGoogle Scholar
  15. 15.
    Venditti D, Gargiani M, Milito G (2001) Parastomal hernia surgery: personal experience with use of polypropylene mesh. Tech Coloproctol 5:85–88PubMedCrossRefGoogle Scholar
  16. 16.
    Luning TH, Spillenaar-Bilgen EJ (2009) Parastomal hernia: complications of extra-peritoneal onlay mesh placement. Hernia 13:487–490PubMedCrossRefGoogle Scholar
  17. 17.
    Amin SN, Armitage NC, Abercrombie JF et al (2001) Lateral repair of parastomal hernia. Ann R Coll Surg Engl 83:206–208PubMedCentralPubMedGoogle Scholar
  18. 18.
    Kald A, Landin S, Masreliez C, Sjödahl R (2001) Mesh repair of parastomal hernias: new aspects of the onlay technique. Tech Coloproctol 5:169–171PubMedCrossRefGoogle Scholar
  19. 19.
    Saclarides TJ, Hsu A, Quiros R (2004) In situ mesh repair of parastomal hernias. Am Surg 70:701–705PubMedGoogle Scholar
  20. 20.
    Gurita P, Popa R, Bălălău B, Scăunaşu R (2012) Parastomal hernia mesh repair, variant of surgical technique without stoma relocation. J Med Life 5:157–161PubMedCentralPubMedGoogle Scholar
  21. 21.
    Franks ME, Hrebinko RL (2001) Technique of parastomal hernia repair using synthetic mesh. Urology 57:551–553PubMedCrossRefGoogle Scholar
  22. 22.
    Tekkis PP, Kocher HM, Payne JG (1999) Parastomal hernia repair: modified Thorlakson technique, reinforced by polypropylene mesh. Dis Colon Rectum 42:1505–1508PubMedCrossRefGoogle Scholar
  23. 23.
    Kasperk R, Klinge U, Schumpelick V (2000) The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg 179:186–188PubMedCrossRefGoogle Scholar
  24. 24.
    Longman RJ, Thompson WH (2005) Mesh repair of parastomal hernias—a safety modification. Colorectal Dis 7:292–294PubMedCrossRefGoogle Scholar
  25. 25.
    Guzman-Valdivia G, Guerrero TS, Laurrabaquio HV (2008) Parastomal hernia repair using mesh and an open technique. World J Surg 32:465–470PubMedCrossRefGoogle Scholar
  26. 26.
    Liu F, Jiye L, Yao S, Zhu Y, Yao J (2010) In situ repair of parastomal hernia with sublay methods in 34 cases. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 24:933–936PubMedGoogle Scholar
  27. 27.
    Byers JM, Steinberg JB, Postier RG (1992) Repair of parastomal hernias using polypropylene mesh. Arch Surg 127:1246–1247PubMedCrossRefGoogle Scholar
  28. 28.
    Morris-Stiff G, Hughes LE (1998) The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl 80:184–187PubMedCentralPubMedGoogle Scholar
  29. 29.
    Hofstetter WL, Vukasin P, Ortega AE et al (1998) New technique for mesh repair of paracolostomy hernias. Dis Colon Rectum 41:1054–1055PubMedCrossRefGoogle Scholar
  30. 30.
    Van Sprundel TC, Gerritsen van der Hoop A (2005) Modified technique for parastomal hernia repair in patients with intractable stoma care problems. Colorectal Dis 7:445–449PubMedCrossRefGoogle Scholar
  31. 31.
    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 47:185–191PubMedCrossRefGoogle Scholar
  32. 32.
    Janes A, Weisby L, Israelsson LA (2011) Parastomal hernia: clinical and radiological definitions. Hernia 15:189–192PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  1. 1.Department of SurgerySandwell HospitalWest BromwichUK
  2. 2.Department of Colorectal SurgeryNew Cross HospitalWolverhamptonUK
  3. 3.BirminghamUK

Personalised recommendations