Incidence of parastomal hernia after open versus minimally invasive surgery: a comparative systematic review

Peristomal bulging and external stoma prolapse are the most common long-term complications following stoma formation. This systematic review aims to describe available evidence on the incidence of parastomal hernia, subcutaneous prolapse and external stomal prolapse following open versus minimally invasive intestinal resections with definitive stoma formation.

In this systematic review and meta-analysis, a literature search was performed to include studies published in the last 15 years on intestinal resections with a definitive ileostomy or colostomy formation and a follow-up of more than 12 months, reporting on PSH and/or subcutaneous prolapse and/or external stoma prolapse after laparoscopic or robotic, and open surgery. The incidence of PSH after open versus minimally invasive surgery was the primary outcome, and secondary outcomes included other stoma-related complications such as subcutaneous stoma prolapse and external stoma prolapse, and outcomes.

In total six studies (one randomised controlled trial and five observational studies) on 1480 patients with a definitive stoma were included (731 open, 749 laparoscopic). All studies reported PSH as an outcome, no study reported the incidence of subcutaneous prolapse and one study reported on external stoma prolapse. There was consistent trend toward higher PSH rates following laparoscopic resections, both in clinically (RR 1.89 (95% CI 1.39-2.58)) and radiologically (RR 1.70 (95% CI 0.89-3.28)) assessed hernias.

Minimally invasive intestinal resection may be associated with a higher incidence of PSH than open surgery, but the certainty of the evidence is very low. Subcutaneous prolapse is seldom recognised as a distinct form of stoma herniation. Clear differentiation is essential, as these conditions differ in their underlying mechanisms and management.

PROSPERO CRD420251026395.