Non‐operative treatment as a strategy for patients with parastomal hernia: a multicentre, retrospective cohort study

• Published in: Colorectal disease 2018-06, Vol.20 (6), p.545-551
• Main Authors: Kroese, L. F., Lambrichts, D. P. V., Jeekel, J., Kleinrensink, G. J., Menon, A. G., de Graaf, E. J. R., Bemelman, W. A., Lange, J. F.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asymptomatic Diseases; Cohort analysis; Cohort Studies; Colostomy; Comorbidity; Complications; Conservative Treatment; Female; Hernia; Hernia, Abdominal - therapy; Hernias; Herniorrhaphy; Humans; Ileostomy; Ileus - epidemiology; Incisional Hernia - therapy; Male; Middle Aged; non‐operative treatment; Ostomy; Parastomal hernia; Patient Preference; Patients; Postoperative Complications - epidemiology; Postoperative Complications - therapy; Recurrence; Retrospective Studies; Surgery; Surgical Mesh; Surgical Stomas; surgical treatment; Surgical Wound Infection - epidemiology; Suture Techniques; Urinary Diversion
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13962

Aim Parastomal hernia is the most common complication following stoma construction. Surgical treatment is usually chosen over non‐operative treatment, but a clear rationale for the choice of management is often lacking. This study aims to investigate the reasons for non‐operative treatment, cross‐over rates and postoperative complications. Method A multicentre, retrospective cohort study was conducted. Patients diagnosed with a parastomal hernia between January 2007 and December 2012 were included. Data on baseline characteristics, primary surgery and hernias were collected. For non‐operative treatment, reasons for this treatment and cross‐over rates were evaluated. For all patients undergoing surgery (surgical treatment and cross‐overs), complication and recurrence rates were analysed. Results Of the 80 patients included, 42 (53%) were in the surgical treatment group and 38 (48%) in the non‐operative treatment group. Median follow‐up was 46 months (interquartile range 24–72). The reasons for non‐operative treatment were absence of symptoms in 12 patients (32%), comorbidities in nine (24%) and patient preference in three (7.9%). In 14 patients (37%) reasons were not documented. Eight patients (21%) crossed over from non‐operative treatment to surgical treatment, of whom one needed emergency surgery. In 23 patients (55%), parastomal hernia recurred after the original surgical treatment, of whom 21 (91%) underwent additional repair. Conclusion Parastomal hernia repair is associated with high recurrence and additional repair rates. Non‐operative treatment has a relatively low cross‐over and emergency surgery rate. Given these data, non‐operative treatment might be a better choice for patients without complaints or with comorbidities.