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

Parastomal hernia (PSH) is very common. Recent reports suggest increased frequency after laparoscopic stoma formation compared with open surgery. A retrospective chart review was designed to appraise the outcomes regarding PSH in open and in laparoscopic procedures.

All patients operated by rectal resection and planned end-colostomy in the period from 2004 to 2018 were reviewed. A total of 70 open and 101 laparoscopic operations were identified. A modified retromuscular mesh application through the trephine was used for the prevention of PSH in 42% of patients in the laparoscopic group.

The median follow-up was 58 (1 to 167) months in the open group and 43 (0 to 153) months in the laparoscopic group. Patient characteristics were evenly distributed between the groups, except for more male patients and higher American Society of Anesthesiologists Score as well as higher rates of patients with neoadjuvant treatment and mesh prophylaxis, in the laparoscopic group. Clinical PSH occurrences were 2 (3%) in the open group and 18 (18%) in the laparoscopic group (P=0.00). Propensity-weighted analysis estimates increased odds ratio (OR) for PSH in the laparoscopic group [OR=11.8; 95% confidence interval (CI): 1.4-96.6]. PSH repair rates were 0 in the open group and 6/18 (33%) in the laparoscopic group. Mesh prophylaxis in the laparoscopic group did not influence PSH outcome (OR=1.4; 95% CI: 0.5-4.0). Computed tomography scans were assessable in 48 and 66 patients, with median follow-up timepoints of 42 and 30 months in the open and laparoscopic groups, respectively, and 8 (18%) and 21 patients (32%) were diagnosed with PSH. Computed tomography assessment implied an increased risk for PSH in laparoscopy (OR=3.5; 95% CI: 1.1-11.9). Aggregate of chart and computed tomography occurrence of PSH showed an equivalent hazard (OR=3.2; 95% CI: 1.1-9.5).

Laparoscopic operations with stoma formation seem to have an increased rate of PSH in comparison with open operations and the results support previous claims. Retromuscular keyhole mesh placement may not be the ideal method of PSH prevention in laparoscopic stoma formation.