Parastomal hernia repair: A 10-year retrospective study at District General Hospital—Recurrence and complications

Abstract

Abstract BACKGROUND: Parastomal hernia (PSH) is the most common long-term complication of stoma formation. The reported occurrence rate of PSH is 48.1% after colostomy and 28.3% after ileostomy formation. Most PSHs occur within the first 2 years of the formation of the stoma. The standard treatment modality for PSH has remained surgical repair. The aim of this study was to assess our practice of PSH surgery in terms of PSH recurrence and associated complications at our hospital. MATERIALS AND METHODS: This study involved retrospective continuous data collection of all patients coded as having PSH repair on the electronic patients’ record system over a period of 10 years from January 2011 till December 2020 at our District General Hospital. This study included all patients over the age of 16 years who had PSH repair done (open or laparoscopic; simple suture repair or mesh repair). Patients were followed up for a period of 12–36 months. The data were then analyzed for hernia recurrence, wound infection, and any other perioperative complications. RESULTS: A total of 47 patients were identified during the study period. There were 29 male and 18 female patients, with a male:female ratio of 67.75%:38.3%. There were 29 cases with colostomy (61.7%) and 18 cases with a history of ileostomy formation (38.3%). The age of the patients ranged between 45 and 87 years, with the mean age and standard deviation (SD) of 64.51 ± 10.32. Mesh repair was performed in 41 of 47 patients. The overall recurrence rate of PSH repair was 29.78% in our cohort. The recurrence rate in open surgery was significantly higher (38.8%) as compared with laparoscopic repair (24.13%). The recurrence rate in the mesh group was 29.2%, with synthetic mesh subgroup having lower recurrence rate compared with the biological mesh group (25%:38.46%). The primary suture repair group had a higher incidence of recurrence in this study (33.3%), although total number in this group was low (6). In the mesh group, the Sugarbaker technique was used in 26 (63.5%) cases, keyhole technique in 12 (29.2%), and sublay/onlay technique in 3 (7.3%) cases. In our cohort, highest recurrence was noted after the keyhole technique followed by primary suture repair and Sugarbaker technique with values of 41.6%, 33.3%, and 30.7%, respectively. No statistically significant difference was noted when data were compared for the risk of recurrent PSH in terms of the type of mesh or the repair technique of the hernia. Overall, the complication rate was 24.3% with wound infection being the most common (19%). Other complications noted were small bowel ileus, small bowel obstruction, hospital acquired pneumonia, atrial fibrillation, acute kidney injury, stoma necrosis, and iatrogenic ureteral injury. No mortality was noted within 30 days after surgery. CONCLUSION: The PSH recurrence rate and PSH surgery associated complications at our trust are comparable with the national and international data. These rates are significant and unacceptably high. We suggest a dedicated parastomal national hernia registry and multihospital randomized trials to keep looking for the optimal surgical repair of PSH to improve the surgical outcomes for this condition.