Mini-invasive Surgery and Parastomal Hernia: Higher Frequency and No Prophylactic Mesh Effect

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Surgery

Background:

• Parastomal hernia (PSH) is a common complication following stoma formation.
• Recent evidence suggests a potential increase in PSH incidence after laparoscopic procedures compared to open surgery.

Purpose of the Study:

• To compare the outcomes of parastomal hernia (PSH) in patients undergoing open versus laparoscopic rectal resection with end-colostomy.
• To evaluate the effectiveness of a modified retromuscular mesh application for PSH prevention in laparoscopic surgery.

Main Methods:

• Retrospective chart review of 171 patients (70 open, 101 laparoscopic) who underwent rectal resection and end-colostomy between 2004 and 2018.
• Analysis of clinical PSH occurrence and PSH repair rates.
• Assessment of PSH incidence via computed tomography (CT) scans.
• Propensity-weighted analysis to adjust for patient characteristics and treatment variations.

Main Results:

• Clinical PSH occurred in 3% of the open group versus 18% in the laparoscopic group (P=0.00).
• Laparoscopic surgery was associated with significantly increased odds of PSH (OR=11.8).
• CT assessment revealed a higher PSH risk in laparoscopy (OR=3.5), with an aggregate risk increase (OR=3.2).
• Mesh prophylaxis in the laparoscopic group did not significantly reduce PSH incidence (OR=1.4).

Conclusions:

• Laparoscopic stoma formation appears to be associated with a higher incidence of parastomal hernia compared to open surgery.
• The retromuscular keyhole mesh placement technique may not be optimal for preventing PSH in laparoscopic procedures.