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Parastomal hernia. Is stoma relocation superior to fascial repair?
M S Rubin1, D J Schoetz, J B Matthews
1Department of Colorectal Surgery, Lahey Clinic, Burlington, Mass.
Objective:
To evaluate methods of parastomal hernia repair.
Design:
Retrospective analysis.
Setting:
Two tertiary care institutions.
Patients:
Eighty patients undergoing 94 parastomal hernia repairs between 1983 and 1991.
Interventions:
Three methods of repair were examined: fascial repair, stoma relocation, and fascial repair with prosthetic material.
Main Outcome Measure:
Parastomal hernia recurrence and short- and long-term complications.
Results:
Fifty-five (93%) of 59 living patients were available and examined at a median of 31.5 months following repair, providing 68 repairs for consideration. Fascial repair was used in 36 cases, stoma relocation in 25 cases, and fascial repair with prosthetic material in seven cases. Overall, 63% of patients developed a recurrent parastomal hernia and 63% had at least one postoperative complication. Following first-time repair, parastomal hernia recurrence developed in 22 (76%) of 29 patients who had fascial repair but in only six (33%) of 18 patients who had stoma relocation (P < .01). When repair was undertaken for recurrent parastomal hernia, fascial repair failed in all seven cases, stoma relocation failed in five (71%) of seven cases, and fascial repair with prosthetic material failed in one (33%) of three cases. The only factor that significantly affected the recurrence rate was the technique of repair. Complications were more common following stoma relocation (88%) than following fascial repair (50%) (P < .05). In particular, incisional hernias developed in 52% of patients following stoma relocation but in only 3% of patients following fascial repair. When postoperative occurrence of all abdominal-wall hernias was compared, there was no significant difference between the fascial repair group (29 [81%] of 36 repairs) and the stoma relocation group (17 [68%] of 25 repairs). Furthermore, the reoperation rate for hernia repair was nearly identical (31% vs 28%) between these two groups.
Conclusions:
Parastomal hernia repair is often unsuccessful and rarely without complication. For first-time parastomal hernia repairs, stoma relocation is superior to fascial repair. For recurrent parastomal hernias, repair with prosthetic material is the most promising of a group of poor alternatives.