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Surgery of recurrent parastomal hernia: direct repair or relocation?
Author(s) -
Riansuwan W.,
Hull T. L.,
Millan M. M.,
Hammel J. P.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.01868.x
Subject(s) - medicine , stoma (medicine) , surgery , hernia , perioperative , complication , relocation , general surgery , retrospective cohort study , surgical mesh , computer science , programming language
Purpose Parastomal hernia is a common late complication after stoma creation. The management options are many; unfortunately, most literature suggests unsatisfactory results. There are few studies comparing the outcomes after repair of parastomal hernias especially in recurrent cases, and the results are controversial. The aim of this study was to compare outcomes after repair of recurrent parastomal hernias between direct repair (DR) and relocation (RL). Method We performed a retrospective chart review of patients who underwent direct repair or RL for recurrent parastomal hernia during the period between 1990 and 2005. Perioperative data and re‐recurrence rates were obtained and analysed with appropriate statistical methods. Results With mean follow‐up time of 2 years, 50 operations were available for evaluation; 27 (54%) DR and 23 (46%) RL [five same‐side RL (SSRL) and 18 opposite‐side RL (OSRL)]. There were no deaths and there were similar complication rates between groups. Four of five (80%) SSRL had a re‐recurrent parastomal hernia. Considering only DR with OSRL, although OSRL had longer operative time and hospital stay than DR, the re‐recurrence rate was lower (38% vs 74%; P = 0.02). However, with Kaplan–Meier calculated and longer predicted follow‐up time, re‐recurrence rates were similar (Log rank P = 0.09). Conclusion Recurrent parastomal hernia repair is associated with high re‐recurrence rates.OSRL seems to have promising short‐term outcomes; however, whether these results hold up long‐term remains unclear. Therefore, larger cohorts of patients with longer follow‐up or prospective randomized trials are needed.