Sigmoidostomy-related parastomal hernia

Abstract

Background and aims: The aim was to examine prevalence and treatment of parastomal hernias in patients with sigmoidostomy.

Materials and methods: In 2009, the medical records of 447 consecutive patients operated with a sigmoidostomy from January 1999 to December 2008 were retrospectiely reviewed. 119 dead patients (26.6%) were excluded because of short follow up (n = 59) and insufficient clinical data (n = 60). 328 patients (73.4%) were followed-up, of whom 210 (64%) alive patients also were scrutinized for presence of parastomal hernia by phone interview. In 2010, 92 out of 153 alive patients (60.1%) without known parastomal hernia also underwent targeted clinical examination in the ambulatory unit.

Results and conclusion: Follow up from stoma operation in 328 patients was median 20 (range 1-129) months. 319 patients had an end sigmoidostomy and nine patients had a loop sigmoidostomy. Time to parastomal hernia in 66 patients (20.1%) was median 9 (1-54) months. Fourty four patients (66.7%) reported no symptoms, eight (12.1%) had mild discomfort, six (9.1%) leakage, six (9.1%) pain, and two (3%) episodes of intestinal obstruction. Eleven (16.7%) had a hernia operation, eight with onlay mesh repair complicated with bowel perforation and ventral hernia in one patient. Three with mesh repair (37.5%) developed recurrent parastomal hernia, of whom one had tissue repair and a second recurrence 6 months later. The only patient with initial tissue repair had a recurrent hernia successfully treated with mesh repair. Two patients had their stoma uneventfully reversed. Parastomal hernia rate, mainly treated with mesh repair, was fairly low in this heterogenous patient series.