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
