Skip to main content

Advertisement

SpringerLink
Log in

Changes in the Surgical Management of Parastomal Hernias Over 15 Years: Results of 135 Cases

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Over the years, various open and laparoscopic approaches toward the repair of parastomal hernias (PSH) have been described. The variety of published techniques itself can be seen as an indicator for the often low level of satisfaction reached with the surgical procedures.

Methods

From January 1999 to January 2014, we assessed all cases of PSH repair performed at the three participating surgical departments in a retrospective analysis. The results were evaluated with regard to different surgical techniques focusing on complications and recurrences.

Results

One hundred and thirty-five individuals could be included in the analysis. They were operated on with eight different surgical techniques. Laparoscopic procedures were carried out in 46.7 % (63/135) of the cases. Median follow-up was 54 months (12–146 months). We found 44 cases of recurrence (32.6 %) and 24 (17.8 %) of the patients experienced perioperative complications and 12 of them needed to return to theater. Fourteen of the 135 patients (10.4 %) were operated as emergency cases which were associated with a mortality of 28.6 % (4/14). In case of elective PSH repair, no mortality occured.

Conclusion

The results achieved by direct suture or the use of incised flat meshes for the repair of PSH were poor with these procedures having unacceptably high recurrence rates. With regard to the latter ostomy revision through three-dimensional funnel-shaped meshes and the laparoscopic sandwich technique showed the best results. Emergency procedures were linked to a dramatic increase in morbidity and mortality (p < 0.001).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pearl RK (1989) Parastomal hernias. World J Surg 13(5):569–572. doi:10.1007/BF01658872

    Article  CAS  PubMed  Google Scholar 

  2. Pilgrim CH, McIntyre R, Bailey M (2010) Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum 53(1):71–76

    Article  PubMed  Google Scholar 

  3. Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90(7):784–793

    Article  CAS  PubMed  Google Scholar 

  4. Cingi A, Cakir T, Sever A et al (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49(10):1559–1563

    Article  PubMed  Google Scholar 

  5. Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37(9):916–920

    Article  CAS  PubMed  Google Scholar 

  6. Moreno-Matias J, Serra-Aracil X, Darnell-Martin A et al (2009) The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 11(2):173–177

    Article  CAS  PubMed  Google Scholar 

  7. Śmietański M, Szczepkowski M, Alexandre JA et al (2014) European hernia society classification of parastomal hernias. Hernia 18(1):1–6

    Article  PubMed Central  PubMed  Google Scholar 

  8. Helgstrand F, Rosenberg J, Kehlet H et al (2013) Risk of morbidity, mortality, and recurrence after parastomal hernia repair: a nationwide study. Dis Colon Rectum 56(11):1265–1272

    Article  PubMed  Google Scholar 

  9. Gregg ZA, Dao HE, Schechter S, Shah N (2014) Paracolostomy hernia repair: who and when? J Am Coll Surg 218(6):1105–1112

    Article  PubMed  Google Scholar 

  10. Berger D (2008) Prevention of parastomal hernias by prophylactic use of a specially designed intraperitoneal onlay mesh (Dynamesh IPST). Hernia 12(3):243–246

    Article  CAS  PubMed  Google Scholar 

  11. Köhler G, Koch OO, Antoniou SA et al (2014) Parastomal hernia repair with a 3-D mesh device and additional flat mesh repair of the abdominal wall. Hernia 18(5):653–661

    Article  PubMed  Google Scholar 

  12. Stechemesser B, Jacob DA, Schug-Paß C et al (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16(3):269–276

    Article  CAS  PubMed  Google Scholar 

  13. Berger D, Bientzle M (2007) Laparoscopic repair of parastomal hernias: a single surgeon’s experience in 66 patients. Dis Colon Rectum 50(10):1668–1673

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Clavien–Dindo classification of surgical complications. Ann Surg 244:931–937

    Google Scholar 

  15. Hansson BM (2013) Parastomal hernia: treatment and prevention 2013; where do we go from here? Colorectal Dis 15(12):1467–1470

    Article  CAS  PubMed  Google Scholar 

  16. Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255(4):685–695

    Article  PubMed  Google Scholar 

  17. Hansson BM, Morales-Conde S, Mussack T et al (2013) The laparoscopic modified Sugarbaker technique is safe and has a low recurrence rate: a multicenter cohort study. Surg Endosc 27(2):494–500

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. 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):267–270

    Article  CAS  PubMed  Google Scholar 

  19. Hansson BM, Bleichrodt RP, de Hingh ICH (2009) Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate. Surg Endosc 23(7):1456–1459

    Article  CAS  PubMed  Google Scholar 

  20. Al Shakarchi J, Williams JG (2014) Systematic review of open techniques for parastomal hernia repair. Tech Coloproctol 18(5):427–432

    Article  CAS  PubMed  Google Scholar 

  21. Slater NJ, Hansson BM, Buyne OR et al (2011) Repair of parastomal hernias with biologic grafts: a systematic review. J Gastrointest Surg 15(7):1252–1258

    Article  PubMed Central  PubMed  Google Scholar 

  22. Tam KW, Wei PL, Kuo LJ, Wu CH (2010) Systematic review of the use of a mesh to prevent parastomal hernia. World J Surg 34(11):2723–2729. doi:10.1007/s00268-010-0739-2

    Article  PubMed  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank their hospitals’ stoma care nurses for their highly valuated support and long-standing empathic care in the management of all our patients with ostomies and stoma-related problems as well as for supplying their records.

Author information

Author notes

    Authors and Affiliations

    1. Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria

      Gernot Köhler, Helwig Wundsam & Klaus Emmanuel

    2. Academic Teaching Hospital of the Medical Universitiy of Graz, Graz, Austria

      Gernot Köhler, Helwig Wundsam & Klaus Emmanuel

    3. Academic Teaching Hospital of the Medical Universitiy of Innsbruck, Innsbruck, Austria

      Gernot Köhler, Helwig Wundsam & Klaus Emmanuel

    4. Department of Surgery, Hospital Bruck an der Mur, Bruck an der Mur, Austria

      Rudolf Schrittwieser

    5. Department of Surgery, Paracelsus Medical University, Salzburg, Austria

      Gernot Köhler, Franz Mayer & Michael Lechner

    Authors
    1. Gernot Köhler
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Franz Mayer
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Helwig Wundsam
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Rudolf Schrittwieser
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Klaus Emmanuel
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Michael Lechner
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Gernot Köhler.

    Ethics declarations

    Disclosure

    Gernot Koehler, Franz Mayer, Helwig Wundsam, Rudolf Schrittwieser, Klaus Emmanuel, and Michael Lechner have no conflicts of interest or financial ties to disclose. All authors do disclose all institutional or corporate/commercial relationships.

    Additional information

    Gernot Köhler and Franz Mayer have contributed equally to the publication.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Köhler, G., Mayer, F., Wundsam, H. et al. Changes in the Surgical Management of Parastomal Hernias Over 15 Years: Results of 135 Cases. World J Surg 39, 2795–2804 (2015). https://doi.org/10.1007/s00268-015-3187-1

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00268-015-3187-1

    Keywords

    Search

    Navigation