Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair

Abstract

ImportanceDurable parastomal hernia repair remains elusive. There is limited evidence comparing the durability of the open retromuscular Sugarbaker and keyhole mesh configurations.ObjectiveTo determine if the open retromuscular Sugarbaker mesh placement technique would lower parastomal hernia recurrence rates.Design, Setting, and ParticipantsIn this single-center, randomized clinical trial, 150 patients with a permanent stoma and associated parastomal hernia who were candidates for open retromuscular parastomal hernia repair were enrolled and randomized from April 2019 to April 2022 and followed up for 2 years.InterventionsFollowing intraoperative assessment to determine the feasibility of either technique, enrolled patients were randomized to receive either retromuscular Sugarbaker or keyhole synthetic mesh placement.Main Outcomes and MeasuresThe primary outcome was parastomal hernia recurrence at 2 years. Secondary outcomes included mesh-related complications, wound complications, reoperations, as well as patient-reported pain, abdominal wall–specific quality of life, stoma-specific quality of life, and decision regret at 1 year and 2 years.ResultsA total of 150 patients were randomized, and with 91% follow-up at 2 years, there were 13 (17%) parastomal hernia recurrences in the retromuscular Sugarbaker arm and 18 (24%) in the keyhole arm (adjusted risk difference, −0.029; 95% CI, −0.17 to 0.153, and adjusted risk ratio, 0.87; 95% CI, 0.42 to 1.69). There were no statistically significant differences between the Sugarbaker and keyhole groups regarding reoperations for recurrence (2 vs 7, respectively), nonhernia intra-abdominal pathology (4 vs 10, respectively), stoma necrosis (1 vs 0, respectively), mesh-related complications (4 vs 1, respectively), patient-reported pain, abdominal wall–specific quality of life, stoma-specific quality of life, and decision regret at any time point.Conclusions and RelevanceIn the setting of open parastomal hernia repair, a retromuscular Sugarbaker mesh placement technique was not superior to a keyhole configuration 2 years after repair. Further innovation is necessary to improve parastomal hernia repair outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT03972553