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Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807749
Review Article

Prophylactic Operative Interventions for Preventing Parastomal Hernias after Colorectal Surgery

Tyler McKechnie
1   Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
2   Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
,
Neil J. Smart
3   Department of Gastrointestinal Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, United Kingdom
,
Cagla Eskicioglu
1   Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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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.

Keywords

colorectal surgery - parastomal hernia - stomas - colostomy - postoperative complication


Publication History

Article published online:
22 April 2025

© 2025. Thieme. All rights reserved.

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