Long-term outcomes after open parastomal hernia repair at a high-volume center.

Abstract

Background: Open parastomal hernia repairs (OPHR) are complex with high recurrence rates and no clear optimal technique. This report summarizes long-term OPHR outcomes at a high-volume hernia center.

Methods: OPHRs were identified from a prospectively maintained institutional database. Recurrence and wound complication rates were compared across operative techniques using standard statistical analysis.

Results: Of 97 OPHR patients, mean age was 61.9 ± 12.6 years, 56.7% were female, 24.7% were diabetic, and average BMI was 31.3 ± 6.5 kg/m². Mean defect size was 125.3 ± 130.0cm² and 41.2% were recurrent. Stomas included colostomies (56.7%), ileostomies (30.9%), and urostomies (12.4%). Patients underwent concurrent ventral hernia repair (56.7%), panniculectomy (22.7%), and component separation (30.9%). Patients either had their stoma reversed (13.4%), resited (25.8%), or repaired in situ (60.8%) with suture (11.9%) or mesh (88.1%) in a Sugarbaker (65.4%), keyhole (19.2%), or onlay (15.4%) configuration. Over a mean follow-up of 31.6 ± 35.9 months, wound complications occurred in 18.6% and recurrences in 20.6%. There were no significant differences in recurrence by ostomy type. Recurrence rates were highest after in situ suture repair (42.9%), followed by resiting with mesh (34.8%), in situ with mesh (17.3%), and reversal (0.0%)(p = 0.042). When stomas were resited, prophylactic mesh compared to no mesh did not significantly impact recurrence (28.6%vs.50.0%;p = 0.570). Recurrence rates for in situ repairs were not statistically different by mesh technique (onlay 25.0%, Sugarbaker 17.7%, keyhole 10.0%;p = 0.751), but differed by location(retrorectus 50.0%, intraperitoneal 36.4%, onlay 25.0%, preperitoneal 6.5%;p = 0.035). Multivariable analysis did not demonstrate any independent predictors of recurrence or wound complications.

Conclusion: This study represents the largest series to date describing long-term OPHR outcomes with a variety of techniques. Recurrence was greatest after in situ primary repair. There were no recurrences after stoma reversal. After ostomy resiting, all recurrences occurred at the new stoma site, independent of prophylactic mesh use. When the stoma was repaired in situ, preperitoneal mesh placement had the lowest recurrence. Optimal technique for OPHR remains unclear, but these results may inform preoperative discussions and surgical planning.