Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP, et al.
Annals of surgery. Date of publication 2012 Apr 1;volume 255(4):685-95.
1. Ann Surg. 2012 Apr;255(4):685-95. doi: 10.1097/SLA.0b013e31824b44b1.
Surgical techniques for parastomal hernia repair: a systematic review of the
literature.
Hansson BM(1), Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh
IH, Bleichrodt RP.
Author information:
(1)Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The
Netherlands. b.hansson@cwz.nl
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.
DOI: 10.1097/SLA.0b013e31824b44b1
PMID: 22418006 [Indexed for MEDLINE]
