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Surgical Techniques for Parastomal Hernia Repair: A Systematic Review of the Literature

Hansson, Birgitta M.E. MD*; Slater, Nicholas J. MD; van der Velden, Arjan Schouten MD, PhD*; Groenewoud, Hans M.M. MSc; Buyne, Otmar R. MD, PhD; de Hingh, Ignace H.J.T. MD, PhD§; Bleichrodt, Rob P. MD, PhD

doi: 10.1097/SLA.0b013e31824b44b1
Reviews and Meta-Analysis

Background: Parastomal hernias are a frequent complication of enterostomies that require surgical treatment in approximately half of patients. This systematic review aimed to evaluate and compare the safety and effectiveness of the surgical techniques available for parastomal hernia repair.

Methods: Systematic review was performed in accordance with PRISMA. Assessment of methodological quality and selection of studies of parastomal hernia repair was done with a modified MINORS. Subgroups were formed for each surgical technique. Primary outcome was recurrence after at least 1-year follow-up. Secondary outcomes were mortality and postoperative morbidity. Outcomes were analyzed using weighted pooled proportions and logistic regression.

Results: Thirty studies were included with the majority retrospective. Suture repair resulted in a significantly increased recurrence rate when compared with mesh repair (odds ratio [OR] 8.9, 95% confidence interval [CI] 5.2–15.1; P < 0.0001). Recurrence rates for mesh repair ranged from 6.9% to 17% and did not differ significantly. In the laparoscopic repair group, the Sugarbaker technique had less recurrences than the keyhole technique (OR 2.3, 95% CI 1.2–4.6; P = 0.016). Morbidity did not differ between techniques. The overall rate of mesh infections was low (3%, 95% CI 2) and comparable for each type of mesh repair.

Conclusions: Suture repair of parastomal hernia should be abandoned because of increased recurrence rates. The use of mesh in parastomal hernia repair significantly reduces recurrence rates and is safe with a low overall rate of mesh infection. In laparoscopic repair, the Sugarbaker technique is superior over the keyhole technique showing fewer recurrences.

A systematic review was performed in accordance with PRISMA. The quality of available evidence was low. Pooled analyses show that synthetic mesh repairs of parastomal hernias is preferred over local suture repair. In laparoscopic repair, the Sugarbaker technique is superior over the keyhole technique showing fewer recurrences.

*Department of Surgery, Canisius–Wilhelmina Hospital, Nijmegen, The Netherlands

Departments of Surgery

Medical Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

§Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.

Reprints: Birgitta M.E. Hansson, MD, Department of Surgery, Canisius-Wilhelmina Hospital, P.O. Box 9015, 6500 GS, Nijmegen, The Netherlands. E-mail: b.hansson@cwz.nl.

B.M.E.H. and N.J.S. contributed equally to the manuscript.

Disclosure: None of the authors have a conflict of interest or financial tie to disclose. No funding was received from any organization.

© 2012 Lippincott Williams & Wilkins, Inc.