Trends in parastomal hernia repair in the United States: a 14-y review.

BACKGROUND: Parastomal hernia is the most common complication after stoma creation. Parastomal hernias can create significant morbidity, including patient discomfort, small bowel obstruction, and need for emergency surgery. We examined national trends in parastomal hernia repair (PHR) including annual frequency of procedure, patient characteristics, and same-admission complications. MATERIALS AND METHODS: The 1998-2011 Nationwide Inpatient Sample was used to identify patients who underwent a PHR (International Classification of Disease, Ninth Edition, Procedure Code [ICD-9 PR] 46.42). PHRs were classified as PHR with concurrent resiting (ICD-9 PR 46.43), PHR with concurrent ostomy reversal (ICD-9 PR 46.52 or 46.51), or primary PHR. Patient characteristics were collected. Complications, length of stay, cost and inpatient mortality were identified. RESULTS: The estimated number of annual PHRs increased from 4150 to 7623 (P ≤ 0.01) for a total of 73,393 repairs. Thirty percent underwent a concurrent stoma reversal and 10% underwent a resiting. There was an upward trend in number of patients with ≥3 Elixhauser comorbidities (17%-44%, P < 0.01). Length of stay remained steady, with a median of 6.3 d and in-hospital annual mortality ranged from 1.8% to 3.9%. Mortality and emergency admission status were highest for patients who underwent primary PHR. CONCLUSIONS: The incidence of PHR nationwide is increasing and more than half of patients undergo primary repair. Although the surgical focus has moved toward prevention, parastomal hernia is a persistent complication of stoma creation. Further exploration is warranted to determine contributing factors to the observed increase in PHR and changes in surgical technique.

Patients Undergoing Parastomal Hernia Repair Using the Americas Hernia Society Quality Collaborative: A Prospective Cohort Study.

BACKGROUND: Parastomal hernia is the most common complication after stoma creation. It can create significant morbidity and is associated with a lower quality of life. Current parastomal hernia repair techniques and outcomes are not well characterized. We aimed to describe patient characteristics, operative techniques, and outcomes of patients undergoing parastomal hernia repair. STUDY DESIGN: Patients in the Americas Hernia Society Quality Collaborative (AHSQC) ≥18 years old, who underwent parastomal hernia repair were identified. Descriptive statistics were performed for patient demographics, preoperative characteristics, operative details, 30-day follow-up, and patient-reported outcomes. The surgical techniques used in parastomal hernia repair and postoperative outcomes were described, and predictors of open vs minimally invasive surgery (MIS) and type of mesh used were analyzed. RESULTS: We identified 672 patients in the AHSQC who underwent parastomal hernia repair between 2013 and Nov 2017. Almost all operations were elective, 22% of patents had their stoma reversed, and 94% of repairs used mesh. Elective status and surgeon practice type were associated with use of synthetic mesh. A surgeon's preference for MIS, defect size, and age were associated with use of an MIS approach. Quality of life scores improved for patients who completed a postoperative questionnaire. CONCLUSIONS: This is the first multi-institutional report of parastomal hernia repair using prospective data complete with operative details. Parastomal hernia repair remains a difficult operation without a clear best practice. Multiple factors appear to influence operative approach. Surgical treatment may improve quality of life at 6 to 12 months postoperatively.