Surgical treatment of a parastomal hernia

Abstract

Purpose: Parastomal hernia is a major complication of an intestinal stoma. This study was performed to compare the results of various operative methods to treat parastomal hernias.

Methods: Results of surgical treatment for parastomal hernias (postoperative recurrence, complications and postoperative hospital stays) were surveyed in 39 patients over an 11-year period. The patients enrolled in this study underwent surgery by a single surgeon to exclude surgeon bias.

Results: Seventeen patients were male, and twenty-two patients were female. The mean age was 65.9 years (range, 36 to 86 years). The stomas were 35 sigmoid-end-colostomies (90%), 2 loop-colostomies (5%), and 2 double-barrel-colostomies. Over half of the hernias developed within two years after initial formation. Stoma relocation was performed in 8 patients, suture repair in 14 patients and mesh repair in 17 patients. Seven patients had recurrence of the hernia, and ten patients suffered from complications. Postoperative complications and recurrence were more frequent in stoma relocation than in suture repair and mesh repair. Emergency operations were performed in four patients (10.3%) with higher incidence of complications but not with increased risk of recurrence. Excluding emergency operations, complications of relocations were not higher than those of mesh repairs. Postoperative hospital stays were shortest in mesh repair patients.

Conclusion: In this study, mesh repair showed low recurrence and a low complication rate with shorter hospital stay than relocation methods, though these differences were not statistically significant. Further studies, including randomized trials, are necessary if more reliable data on the surgical treatment of parastomal hernias are to be obtained.

Keywords: Complication; Mesh repair; Parastomal hernia; Recurrence; Relocation.

Fig. 1

Development of a parastomal hernia after stoma formation. Over half of the parastomal hernias develop during the first two years after stoma formation. Three patients with obscure dates of stoma formation were excluded from this chart.

Fig. 2

Time point of each operation. Most of the relocation operations were performed in the early period while most of the mesh repairs were performed in the late period. Each ellipse indicates an operative time point. An ellipse with a long bar indicates an emergency operation.

Fig. 3

Recurrence of the hernia according to the operative method. The recurrence curves for each method look separate, but the differences are not statistically significant. The total number of operations is forty-seven.

Fig. 4

Strangulated parastomal hernia. (A) External appearance of the parastomal hernia. Protrusion of the abdominal wall around the stoma opening. (B) Strangulated small bowel in a parastomal hernia.

Fig. 5

Mesh repair of a parastoma hernia. (A) The hernia sac is opened during the operation to examine the herniated bowel and to facilitate reduction to the peritoneal cavity. (B) After repair of the fascia, mesh was overlaid to reinforce the abdominal wall around stoma.