Long-term outcomes of open local onlay mesh parastomal hernia repair with ostomy revision

Parastomal hernia is a frequent long-term complication after stoma creation, and recurrence after repair remains a major clinical problem. Open local onlay mesh parastomal hernia repair with ostomy revision (OLOMPHROR) is a technique for which contemporary long-term outcome data are limited.

We conducted a retrospective cohort study of consecutive adults undergoing open onlay mesh repair for parastomal hernia at a single academic center (2014-2025). Patient demographics, comorbidities, hernia characteristics, and operative details were collected. The primary outcome was parastomal hernia recurrence, diagnosed clinically or radiographically. Secondary outcomes included 30-day complications and reoperations for any indication. Time-to-recurrence was analyzed using Kaplan-Meier methods and multivariable Cox regression.

A total of 113 patients underwent open local onlay parastomal hernia repair with ostomy revision (mean age 61.4 ± 17.5 years; mean BMI 28.9 ± 6.0 kg/m²); 60 (53.1%) presented with recurrent parastomal hernia. Follow-up was complete for all patients (mean 69.0 ± 34.9 months; median 72). Recurrence occurred in 39 patients (34.5%) at a mean of 24.5 ± 19.9 months (median 24); 61.5% of recurrences were confirmed by CT. Recurrence was more frequent in patients with recurrent versus primary parastomal hernias at baseline (45.0% vs. 22.6%). On multivariable Cox regression, COPD/asthma (HR 2.67, 95% CI 1.07-6.66; p = 0.036) and baseline recurrent parastomal hernia (HR 2.40, 95% CI 1.18-4.88; p = 0.015) independently predicted earlier recurrence, whereas previous cancer was protective (HR 0.28, 95% CI 0.11-0.68; p = 0.005). Smoking was strongly associated with surgical site occurrence and abscess (OR > 11), and diabetes predicted any 30-day complication (OR 3.01). Overall, 44.2% of patients required at least one reoperation during follow-up.

Open onlay parastomal hernia repair with ostomy revision was associated with a 34.5% recurrence rate and a 44.2% reoperation rate at long-term follow-up. COPD/asthma and recurrent parastomal hernia were associated with the highest risk of failure, whereas no operative or technique-related factors were independently associated with recurrence. These findings underscore the importance of careful patient selection and suggest that alternative repair strategies should be considered in high-risk patients.