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Laparoscopic parastomal hernia repair delays recurrence relative to open repair

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Abstract

Background

Mesh repair of parastomal hernia is widely accepted as superior to non-mesh repair, yet the most favorable surgical approach is a subject of continued debate. The aim of this study was to compare the clinical outcomes of open versus laparoscopic parastomal hernia repair.

Methods

An IRB-approved retrospective review was conducted comparing laparoscopic (LPHR) or open (OPHR) parastomal hernia repair performed between 2009 and 2017 at our facilities. Patient demographics, preoperative characteristics, operative details, and clinical outcomes were compared by surgical approach. Subgroup analysis was performed by location of mesh placement. Repair longevity was measured using Kaplan–Meier method and Cox proportional hazards regression. Intention to treat analysis was used for this study based on initial approach to the repair.

Results

Sixty-two patients (average age of 61 years) underwent repair (31 LPHR, 31 OPHR). Patient age, gender, BMI, ASA Class, and comorbidity status were similar between OPHR and LPHR. Stoma relocation was more common in OPHR (32% vs 7%, p = .022). Open sublay subgroup was similar to LPHR in terms of wound class and relocation. Open “Other” and Sublay subgroups resulted in more wound complications compared to LPHR (70% and 48% vs 27%, p = .036). Operative duration and hospital length of stay were less with LPHR (p < .001). After adjustment for prior hernia repair, risk of recurrence was higher for OPHR (p = .022) and Open Sublay and Other subgroups compared to LPHR (p = .005 and p = .027, respectively).

Conclusions

Laparoscopic repair of parastomal hernias is associated with shorter operative duration, decreased length of stay, fewer short-term wound complications, and increased longevity of repair compared to open repairs. Direct comparison of repair longevity between LPHR and OPHR with mesh using Kaplan–Meier estimate is unique to this study. Further study is warranted to better understand methods of parastomal hernia repair associated with fewer complications and increased durability.

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Acknowledgements

We acknowledge and thank the Professional Student Mentored Research Fellowship Program and the University of Kentucky Center for Clinical and Translational Science for their contributions to this project.

Author information

Correspondence to John Scott Roth.

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Conflict of interest

Dr. Roth discloses he has grant funding from Bard and Miromatrix; he is a consultant for Bard, Johnson & Johnson, and Allergan; and he owns stock in Miromatrix. Mr. Keller, Drs. Lin, Totten, Plymale, and Davenport have no conflicts of interest or financial ties to disclose.

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Keller, P., Totten, C.F., Plymale, M.A. et al. Laparoscopic parastomal hernia repair delays recurrence relative to open repair. Surg Endosc (2020). https://doi.org/10.1007/s00464-020-07377-y

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Keywords

  • Hernia repair
  • Hernia recurrence
  • Parastomal hernia
  • Recurrence free probability
  • Prevention