Emergency parastomal hernia repair - a systematic review

PURPOSE: Parastomal hernia is a common complication that may require emergency repair (ePHR). Although 20% of PHRs are performed in an emergency setting, treatment strategies and outcomes are poorly documented. This systematic review aimed to determine the optimal strategy and surgical technique for ePHR.

A literature search was conducted in PubMed, Embase, Web of Science, CINAHL, Cochrane Library and Google Scholar for original studies reporting on ePHR. Primary outcome was rate of reoperation within 90 days. Secondary outcomes were length of stay (LOS) as well as 90-day rates of surgical site infection (SSI), other complications, and mortality.

The search identified 328 studies of which 10 was included totalling 21,877 patients undergoing ePHR. Mean rates for short-term reoperation, SSI, other complications and mortality were 39% (95%-confidence interval 31-49%), 24% (15-37%), 44% (30-59%) and 12% (8-16%), respectively. Median LOS varied between 7 and 13 days. Insufficient data precluded meta-analysis for comparison of (1) open and laparoscopic repair, (2) local repair, relocation and reversal, as well as (3) mesh and suture repair.

Besides considerable LOS, ePHR was associated with high morbidity and mortality. The limited available literature and conflicting data did not entitle recommendation of a specific surgical approach for this patient group. There was no evidence that suggested mesh should be avoided in ePHR. Future studies should investigate a two-stage approach with initial damage control versus one-stage definitive repair. Moreover, studies are warranted to compare open and minimally invasive surgery for ePHR.