Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000049.xml
Download PDF
Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807749
DOI: 10.1055/s-0045-1807749
Review Article
Prophylactic Operative Interventions for Preventing Parastomal Hernias after Colorectal Surgery
Abstract
The most common long-term stoma-related morbidity following colorectal surgery is parastomal hernia formation. Given the risk of developing parastomal hernias and the risk of postoperative complications following their repair, practices have evolved to incorporate prophylactic strategies to reduce the risk of parastomal hernia formation after colorectal surgery. The majority of the data forming the evidence base for parastomal hernia prophylaxis pertains to patients undergoing end colostomy formation in the setting of colorectal cancer. The only prophylactic intervention for prevention of parastomal hernia formation with substantial amounts of high-quality data is the insertion of prophylactic mesh at the index operation for patients undergoing formation of a permanent end colostomy. Other interventions that have been proposed but have less published data substantiating their use include lateral pararectus stoma placement, extraperitoneal stoma creation, circular stoma trephine, and small fascial defects. This chapter will review each of these interventions in detail, along with the associated literature supporting or refuting their use. Additionally, we will discuss other important issues regarding the evidence base for parastomal hernia prophylaxis, parastomal hernia classifications, and risk factors for developing parastomal hernias.
Publication History
Article published online:
22 April 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Garmanova TN, Kazachenko EA, Krylov NN. History of surgery: the evolution of views on the formation of intestinal stoma. Hist Med 2019; 6 (02) 111-117
- 2 Perry WB, Connaughton JC. Abdominoperineal resection: how is it done and what are the results?. Clin Colon Rectal Surg 2007; 20 (03) 213-220
- 3 Yang M, McClure JA, Wanis KN. et al. From formation to closure: Aggregate morbidity and mortality associated with defunctioning loop ileostomies. Dis Colon Rectum 2022; 65 (09) 1135-1142
- 4 Burghgraef TA, Geitenbeek RTJ, Broekman M, Hol JC, Hompes R, Consten ECJ. MIRECA Study Group. Permanent stoma rate and long-term stoma complications in laparoscopic, robot-assisted, and transanal total mesorectal excisions: a retrospective cohort study. Surg Endosc 2024; 38 (01) 105-115
- 5 Back E, Häggström J, Holmgren K. et al. Permanent stoma rates after anterior resection for rectal cancer: risk prediction scoring using preoperative variables. Br J Surg 2021; 108 (11) 1388-1395
- 6 Black P. Stoma care nursing management: cost implications in community care. Br J Community Nurs 2009; 14 (08) 350-355 , 352–355
- 7 Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010; 12 (10) 958-964
- 8 Carne PWG, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg 2003; 90 (07) 784-793
- 9 Śmietański M, Szczepkowski M, Alexandre JA. et al. European Hernia Society classification of parastomal hernias. Hernia 2014; 18 (01) 1-6
- 10 Correa Marinez A, Bock D, Erestam S. et al. Methods of colostomy construction: No effect on parastomal hernia rate: Results from Stoma-const-A randomized controlled trial. Ann Surg 2021; 273 (04) 640-647
- 11 Mäkäräinen-Uhlbäck EJ, Klintrup KHB, Vierimaa MT. et al. Prospective, randomized study on the use of prosthetic mesh to prevent a parastomal hernia in a permanent colostomy: Results of a long-term follow-up. Dis Colon Rectum 2020; 63 (05) 678-684
- 12 Brandsma HT, Hansson BME, Aufenacker TJ. et al.; Dutch Prevent Study Group. Prophylactic mesh placement during formation of an end-colostomy: long-term randomized controlled trial on effectiveness and safety. Ann Surg 2023; 278 (03) e440-e446
- 13 Shabbir J, Chaudhary BN, Dawson R. A systematic review on the use of prophylactic mesh during primary stoma formation to prevent parastomal hernia formation. Colorectal Dis 2012; 14 (08) 931-936
- 14 Tam KW, Wei PL, Kuo LJ, Wu CH. Systematic review of the use of a mesh to prevent parastomal hernia. World J Surg 2010; 34 (11) 2723-2729
- 15 Andersen RM, Klausen TW, Danielsen AK, Vinther A, Gögenur I, Thomsen T. Incidence and risk factors for parastomal bulging in patients with ileostomy or colostomy: a register-based study using data from the Danish Stoma Database Capital Region. Colorectal Dis 2018; 20 (04) 331-340
- 16 Hardt J, Seyfried S, Weiß C, Post S, Kienle P, Herrle F. A pilot single-centre randomized trial assessing the safety and efficacy of lateral pararectus abdominis compared with transrectus abdominis muscle stoma placement in patients with temporary loop ileostomies: the PATRASTOM trial. Colorectal Dis 2016; 18 (02) O81-O90
- 17 Krogsgaard M, Watt T, Danielsen AK. et al. Impact of a parastomal bulge on quality of life - A cross-sectional study of patients from the Danish Stoma Database. Ann Surg 2021; 274 (06) e1085-e1092
- 18 Howard R, Rob F, Thumma J. et al. Contemporary outcomes of elective parastomal hernia repair in older adults. JAMA Surg 2023; 158 (04) 394-402
- 19 Helgstrand F, Henriksen NA. Outcomes of parastomal hernia repair after national centralization. Br J Surg 2022; 110 (01) 60-66
- 20 Henriksen NA, Helgstrand F. Prospective nationwide analysis of long-term recurrence rates after elective ventral, incisional and parastomal hernia repairs. BJS Open 2024; 8 (04) zrae070
- 21 Gil G, Szczepkowski M. A new classification of parastomal hernias–from the experience at Bielański Hospital in Warsaw. Pol Przegl Chir 2011; 83 (08) 430-437
- 22 Moreno-Matias J, Serra-Aracil X, Darnell-Martin A. et al. The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 2009; 11 (02) 173-177
- 23 Kald A, Juul KN, Hjortsvang H, Sjödahl RI. Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 2008; 43 (05) 627-633
- 24 Tabusa H, Blazeby JM, Blencowe N. et al. Protocol for the UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study). Colorectal Dis 2021; 23 (07) 1900-1908
- 25 O'Connell S, Islam S, Sewell B. et al. Hughes abdominal closure versus standard mass closure to reduce incisional hernias following surgery for colorectal cancer: the HART RCT. Health Technol Assess 2022; 26 (34) 1-100
- 26 El-Hussuna A, Krag A, Olaison G, Bendtsen F, Gluud LL. The effect of anti-tumor necrosis factor alpha agents on postoperative anastomotic complications in Crohn's disease: a systematic review. Dis Colon Rectum 2013; 56 (12) 1423-1433
- 27 Niu N, Du S, Yang D. et al. Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37 (03) 507-519
- 28 Sørensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jørgensen LN. Smoking is a risk factor for incisional hernia. Arch Surg 2005; 140 (02) 119-123
- 29 Brandsma HT, Hansson BME, Aufenacker TJ. et al.; Dutch Prevent Study group. Prophylactic mesh placement during formation of an end-colostomy reduces the rate of parastomal hernia: Short-term results of the Dutch PREVENT-trial. Ann Surg 2017; 265 (04) 663-669
- 30 Jänes A, Cengiz Y, Israelsson LA. Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 2009; 33 (01) 118-121 , discussion 122–123
- 31 Ringblom C, Odensten C, Strigård K, Gunnarsson U, Näsvall P. No reduction in parastomal hernia rate 3 years after stoma construction with prophylactic mesh: Three-year follow-up results from STOMAMESH-A multicenter double-blind randomized controlled trial. Ann Surg 2023; 277 (01) 38-42
- 32 Hammond TM, Huang A, Prosser K, Frye JN, Williams NS. Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 2008; 12 (05) 475-481
- 33 Fleshman JW, Beck DE, Hyman N, Wexner SD, Bauer J, George V. PRISM Study Group. A prospective, multicenter, randomized, controlled study of non-cross-linked porcine acellular dermal matrix fascial sublay for parastomal reinforcement in patients undergoing surgery for permanent abdominal wall ostomies. Dis Colon Rectum 2014; 57: 623-631 . Lippincott Williams and Wilkins
- 34 Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J. et al. Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 2009; 249 (04) 583-587
- 35 Odensten C, Strigård K, Rutegård J. et al. Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: A randomized controlled trial-STOMAMESH. Ann Surg 2019; 269 (03) 427-431
- 36 Prudhomme M, Eric Rullier ÃY, Lakkis Z. et al. End colostomy with or without mesh to prevent a parastomal hernia (GRECCAR 7): A prospective, randomized, double blinded, multicentre trial. Ann Surg 2021; 274 (06) 928-934
- 37 Mohiuddin S, Hollingworth W, Rajaretnam N, Reeves BC, Smart NJ. Use of prophylactic mesh during initial stoma creation to prevent parastomal herniation: a systematic review and meta-analysis of randomised controlled trials. Colorectal Dis 2021; 23 (11) 2821-2833
- 38 McKechnie T, Lee J, Lee Y. et al. Prophylactic mesh for prevention of parastomal hernia following end colostomy: an updated systematic review and meta-analysis of randomized controlled trials. J Gastrointest Surg 2022; 26 (02) 486-502
- 39 Patel SV, Zhang L, Chadi SA, Wexner SD. Prophylactic mesh to prevent parastomal hernia: a meta-analysis of randomized controlled studies. Tech Coloproctol 2017; 21 (01) 5-13
- 40 Cross AJ, Buchwald PL, Frizelle FA, Eglinton TW. Meta-analysis of prophylactic mesh to prevent parastomal hernia. Br J Surg 2017; 104 (03) 179-186
- 41 Jones HG, Rees M, Aboumarzouk OM. et al. Prosthetic mesh placement for the prevention of parastomal herniation. Cochrane Database Syst Rev 2018; 7 (07) CD008905
- 42 Tzanis AA, Stabilini C, Muysoms FE. et al. Update systematic review, meta-analysis and GRADE assessment of the evidence on parastomal hernia prevention-A EHS, ESCP and EAES collaborative project. J Abdom Wall Surg 2023; 2: 11550
- 43 Mäkäräinen-Uhlbäck E, Vironen J, Falenius V. et al. Parastomal hernia: A retrospective nationwide cohort study comparing different techniques with long-term follow-up. World J Surg 2021; 45 (06) 1742-1749
- 44 Antoniou SA, Agresta F, Garcia Alamino JM. et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2018; 22 (01) 183-198
- 45 Mohiuddin S, Reeves BC, Smart NJ, Hollingworth W. CIPHER Study Group. A semi-Markov model comparing the lifetime cost-effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing end colostomy creation for rectal cancer. Colorectal Dis 2021; 23 (11) 2967-2979
- 46 Stabilini C, Muysoms FE, Tzanis AA. et al. EHS Rapid Guideline: Evidence-informed european recommendations on parastomal hernia prevention-with ESCP and EAES participation. J Abdom Wall Surg 2023; 2: 11549
- 47 Rosen MJ, Krpata DM, Petro CC. et al. Biologic vs synthetic mesh for single-stage repair of contaminated ventral hernias: A randomized clinical trial. JAMA Surg 2022; 157 (04) 293-301
- 48 Harris HW, Primus F, Young C. et al. Preventing recurrence in clean and contaminated hernias using biologic versus synthetic mesh in ventral hernia repair: The PRICE randomized clinical trial. Ann Surg 2021; 273 (04) 648-655
- 49 López-Borao J, Madrazo-González Z, Kreisler E, Biondo S. Prevention of parastomal hernia after abdominoperineal excision with a prophylactic three-dimensional funnel mesh. Colorectal Dis 2019; 21 (11) 1326-1334
- 50 Ammann Y, Widmann B, Sparn M, Warschkow R, Weitzendorfer M, Brunner W. Prophylactic funnel mesh to prevent parastomal hernia in permanent end colostomy: A retrospective cohort study. Colorectal Dis 2021; 23 (10) 2627-2636
- 51 Badia-Closa J, Comas-Isus J, Centeno-Alvarez A. et al. Parastomal hernia prevention with an intraperitoneal prophylactic 3D-funnel mesh: review of the technique and middle-term results. Hernia 2024; 28 (04) 1129-1135
- 52 Mäkäräinen-Uhlbäck E, Wiik H, Kössi J, Nikberg M, Ohtonen P, Rautio T. Chimney Trial: study protocol for a randomized controlled trial. Trials 2019; 20 (01) 652
- 53 Stephenson BM, Evans MD, Hilton J, McKain ES, Williams GL. Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positioned stoma (LRAPS). Colorectal Dis 2010; 12 (10) 1049-1052
- 54 Hardt J, Meerpohl JJ, Metzendorf MI, Kienle P, Post S, Herrle F. Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation. Cochrane Database Syst Rev 2019; 4 (04) CD009487
- 55 O'neill AC, Townley WA, Hofer SOP. Abdominal Wall Reconstruction. In: Plastic Surgery - Principles and Practice. Elsevier; 2022: 610-621
- 56 Stephenson BM. The lateral rectus abdominis positioned stoma (LRAPS) in the construction of end colostomies, loop ileostomies and ileal conduits. Hernia 2021; 25 (03) 803-808
- 57 Goligher JC. Extraperitoneal colostomy or ileostomy. Br J Surg 1958; 46 (196) 97-103
- 58 Lian L, Wu XR, He XS. et al. Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. Int J Colorectal Dis 2012; 27 (01) 59-64
- 59 Luo J, Singh D, Zhang F. et al. Comparison of the extraperitoneal and transperitoneal routes for permanent colostomy: a meta-analysis with RCTs and systematic review. World J Surg Oncol 2022; 20 (01) 82
- 60 Dong LR, Zhu YM, Xu Q, Cao CX, Zhang BZ. Clinical evaluation of extraperitoneal colostomy without damaging the muscle layer of the abdominal wall. J Int Med Res 2012; 40 (04) 1410-1416
- 61 Heiying J, Yonghong D, Xiaofeng W. et al. A study of laparoscopic extraperitoneal sigmoid colostomy after abdomino-perineal resection for rectal cancer. Gastroenterol Rep (Oxf) 2014; 2 (01) 58-62
- 62 Hong SY, Oh SY, Lee JH, Kim DY, Suh KW. Risk factors for parastomal hernia: based on radiological definition. J Korean Surg Soc 2013; 84 (01) 43-47