Parastomal Hernia: From Definitions and Management to Prevention

Parastomal hernias are a common complication of ostomy formation, with end colostomies twice as likely to develop parastomal hernias. Older age, high body mass index, synchronous chronic diseases, collagen deficit disorders, and medication use increase the risk of parastomal hernia development. Whilst many hernias can be appreciated clinically, computed tomography has an important preoperative role in hernia assessment and treatment planning. Parastomal hernia repair method depends on patient factors, the surgeon’s skill set, the surgical setting where the hernia repair takes place, and the presence or absence of concomitant midline incisional hernia. Where there is no midline incisional hernia, the Sugarbaker technique, minimally invasive or open, is advised. A posterior component separation technique is recommended to repair the parastomal defect when a parastomal hernia is large and (or) there is a midline incisional hernia. There are reported benefits of the laparoscopic approach over open parastomal hernia repair, such as reduced risk of postoperative complications and recurrence. The risk of parastomal hernia occurrence in elective end colostomies may be reduced using prophylactic mesh.