Emergency parastomal hernia repair - a systematic review

Area of Science:

• Surgery
• Gastroenterology
• Abdominal Wall Reconstruction

Background:

• Parastomal hernia (PH) is a frequent complication following ostomy creation.
• A significant portion of PH repairs (20%) are performed emergently (ePHR).
• Optimal strategies and outcomes for ePHR remain poorly documented.

Purpose of the Study:

• To systematically review the literature on emergency parastomal hernia repair (ePHR).
• To identify the optimal surgical strategy and technique for ePHR.
• To document outcomes including reoperation, length of stay, surgical site infection, complications, and mortality.

Main Methods:

• A comprehensive literature search was performed across multiple databases (PubMed, Embase, Web of Science, CINAHL, Cochrane Library, Google Scholar).
• Original studies reporting on ePHR were included.
• Primary outcome was the rate of reoperation within 90 days; secondary outcomes included length of stay (LOS), 90-day surgical site infection (SSI), other complications, and mortality.

Main Results:

• Ten studies involving 21,877 patients undergoing ePHR were included.
• Mean rates were: reoperation 39%, SSI 24%, other complications 44%, and mortality 12%.
• Median LOS ranged from 7 to 13 days; insufficient data prevented meta-analysis comparing different repair techniques (open vs. laparoscopic, local repair vs. relocation vs. reversal, mesh vs. suture).

Conclusions:

• Emergency parastomal hernia repair (ePHR) is associated with substantial length of stay, high morbidity, and mortality.
• Limited and conflicting data preclude recommending a specific surgical approach for ePHR.
• Mesh is not contraindicated in ePHR; future research should compare staged vs. one-stage repair and open vs. minimally invasive surgery.