Parastomal Hernia Prevention and Treatment

Abstract

Parastomal hernia (PH) is the most frequent complication associated with the presence of a colostomy [1]. According to EHS [2], a PH can be defined as an abnormal protrusion of the contents of the abdominal cavity through the abdominal wall defect created during placement of a colostomy, ileostomy, or ileal conduit stoma. The incidence of the disease is variably depicted in current literature biased by the retrospective nature of most of the studies. In recent years thanks to well-conducted RCTs, a clearer picture of the problem has been defined. Considering control arms of RCTs on mesh prophylaxis, the true overall incidence of PH has been estimated to be 55%, with a follow-up ranging from 10 to 80 months [3]. When analyzing time pattern of development, mainly in retrospective studies, it has been showed [4] that the risk of hernia development remains nearly constant over time, confirming the degenerative and iatrogenic nature of the condition. No direct study has ever compared directly techniques of construction, so there’s some form of uncertainty with respect to hernia rates among different type of ostomy. An overview of the literature suggests that end colostomy is associated with the highest incidence of parastomal hernia. Loop ileostomy was associated with a parastomal hernia incidence of 16% at 4 months in a RCT, where diagnosis was done during surgery for continuity restoration [5]. A similar incidence was reported in a case series with a clinical diagnosis of parastomal hernia at a mean follow-up of 9 years [6].