Does the parastomal hernia rate depend on the method of stoma formation? (meta-analysis and review)
https://doi.org/10.33878/2073-7556-2025-24-1-91-102
Abstract
AIM: to compare the effectiveness of different techniques for parastomal hernia prevention.
MATERIALS AND METHODS: a systematic review and meta-analysis were performed in accordance with the PRISMA recommendations for the entire period up to 09/08/2023. The search for papers is carried out in PubMed with keywords “extraperitoneal”, “transperitoneal”, “intraperitoneal”, “rectal cancer”, “abdominoperineal resection”, “parastomal hernia”, “colostomy”, “stoma”, “end colostomy”, “prophylactic mesh”, “mesh”. As a result of the literature selection, 28 studies were included in the meta-analysis — 15 studies for end colostomy with and without an implant; 5 studies comparing intra-abdominal and extraperitoneal end colostomy; 8 studies comparing stoma channels through the rectus abdominis shield (transrectal stoma) and lateral stoma.
RESULTS: the incidence of parastomal hernias is significantly lower for extraperitoneal stoma (p = 0.05) than intraabdominal one (OR = 3.40, CI 1.01–11.44) without significant increase in postoperative morbidity rate (OR = 1.04, CI 0.53–2.02, p = 0.92, OR = 2.22, CI 0.67–7.30, p = 0.19). Mesh significantly decreases the incidence of parastomal hernias (OR = 1.87, CI 1.16–3.01, p < 0.0001) without a consistent increase in postoperative morbidity rate (OR = 0.93, CI 0.47–1.82, p = 0.82). No significant differences were obtained between lateral and transrectal colostomies in the incidence of parastomal hernia (OR = 1.14, CI 0.52–2.52, p = 0.74).
CONCLUSION: the extraperitoneal colostomy and meshes reduce the risk of parastomal hernia.
About the Authors
S. V. Chernyshov
Ryzhikh National Medical Research Center of Coloproctology
Russian Federation
Russian Federation
Stanislav V. Chernyshov
Salyama Adilya st., 2, Moscow, 123423
Yu. S. Khilkov
Ryzhikh National Medical Research Center of Coloproctology
Russian Federation
Russian Federation
Yury S. Khilkov
Salyama Adilya st., 2, Moscow, 123423
N. S. Abdullayeva
Ryzhikh National Medical Research Center of Coloproctology
Russian Federation
Russian Federation
Nuriyat S. Abdullayeva
Salyama Adilya st., 2, Moscow, 123423
A. I. Moskalev
Ryzhikh National Medical Research Center of Coloproctology
Russian Federation
Russian Federation
Aleksey I. Moskalev
Salyama Adilya st., 2, Moscow, 123423
References
1. Achkasov S.I., Vardanyan A.V., Kalashnikova I.A., et al. Intestinal stomas: a guide for doctors. Moscow: Limited Liability Company Publishing Group GEOTAR-Media. 2021;304 p. (in Russ.). doi: 10.33029/9704-6469-4-KS-2021-1-304
2. Ambe PC, Kurz NR, Nitschke C, et al. Intestinal Ostomy. Deutsches Arzteblatt international. 2018;115(11):182–187.
3. Maydick D. A Descriptive Study Assessing Quality of Life for Adults With a Permanent Ostomy and the Influence of Preoperative Stoma Site Marking. Ostomy/wound management. 2016;62(5):14–24.
4. Feddern M-L, Emmertsen KJ, Laurberg S. Life with a stoma after curative resection for rectal cancer: a population-based cross-sectional study. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2015;17(11):1011– 1017.
5. Maglio A, Malvone AP, Scaduto V, et al. The frequency of early stomal, peristomal and skin complications. British journal of nursing (Mark Allen Publishing). 2021;30(22):1272–1276.
6. Malik T, Lee MJ, Harikrishnan AB. The incidence of stoma related morbidity — a systematic review of randomised controlled trials. Annals of the Royal College of Surgeons of England. 2018;100(7):501– 508.
7. Correa Marinez A, Bock D, Carlsson E, et al. Stoma-related complications: a report from the Stoma-Const randomized controlled trial. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2021;23(5):1091– 1101.
8. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2010;12(10):958–964.
9. Colvin J, Rosenblatt S. Surgical Management of Parastomal Hernias. The Surgical clinics of North America. 2018;98(3):577–592.
10. Goligher JC. Extraperitoneal colostomy or ileostomy. The British journal of surgery. 1958;46(196):97–103.
11. Eropkin P.V., Shelygin Yu.A., Frolov S.A., et al. Prevention of complications of terminal colostomy. Moscow: Publishing house “Medicine”. 1991; 17 p. (in Russ.).
12. Lian L, Wu X-R, He X-S, et al. Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. International journal of colorectal disease. 2012;7(1):59–64.
13. Takahashi H, Takasu K, Nakaya S, et al. Laparoscopic extraperitoneal sigmoid colostomy using the totally extraperitoneal hernia repair technique after abdominoperineal resection for rectal cancer. Surgery today. 2019;49(11):977–980.
14. Sugarbaker PH. Prosthetic mesh repair of large hernias at the site of colonic stomas. Surgery, gynecology & obstetrics. 1980;150(4):576–578.
15. López-Cano M, Adell-Trapé M, Verdaguer-Tremolosa M, et al. Parastomal hernia prevention with permanent mesh in end colostomy: failure with late follow-up of cohorts in three randomized trials. Hernia : the journal of hernias and abdominal wall surgery. 2023;27(3):657–664.
16. Eldrup J, Wied U, Bischoff N, et al. Post-colostomy hernias. Incidence and relation to placing of the stoma. Ugeskrift for laeger. 1982;144(50):3742–3743.
17. Hardt J, Meerpohl JJ, Metzendorf M-I, et al. Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation. The Cochrane database of systematic reviews. 2019;4(4):CD009487.
18. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine. 2009;6(7):e1000100–e1000100.
19. Hammond TM, Huang A, Prosser K, et al. Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia : the journal of hernias and abdominal wall surgery. 2008;12(5):475–481.
20. Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, et al. Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Annals of surgery. 2009;249(4):583–587.
21. Jänes A, Cengiz Y, Israelsson LA. Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World journal of surgery. 2009;33(1):113–118.
22. Ventham NT, Brady RR, Stewart RG, et al. Prophylactic mesh placement of permanent stomas at index operation for colorectal cancer. Annals of the Royal College of Surgeons of England. 2012;94(8):569–573.
23. López-Cano M, Lozoya-Trujillo R, Quiroga S, et al. Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia : the journal of hernias and abdominal wall surgery. 2012;16(6):661– 667.
24. Târcoveanu E, Vasilescu A, Cotea E, et al. Parastomal hernias — clinical study of therapeutic strategies. Chirurgia (Bucharest,Romania. 1990. 2014;109(2):179–184.
25. Fleshman JW, Beck DE, Hyman N, et al. A prospective, multicenter, randomized, controlled study of non-cross-linked porcine acellular dermal matrix fascial sublay for parastomal reinforcement in patients undergoing surgery for permanent abdominal wall ostomies. Diseases of the colon and rectum. 2014;57(5):623–631.
26. Nikberg M, Sverrisson I, Tsimogiannis K, et al. Prophylactic stoma mesh did not prevent parastomal hernias. International journal of colorectal disease. 2015;30(9):1217–1222.
27. Lambrecht JR, Larsen SG, Reiertsen O, et al. Prophylactic mesh at end-colostomy construction reduces parastomal hernia rate: a randomized trial. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2015;17(10):O191-7.
28. Mäkäräinen-Uhlbäck EJ, Klintrup KHB, Vierimaa MT, et al. Prospective, Randomized Study on the Use of Prosthetic Mesh to Prevent a Parastomal Hernia in a Permanent Colostomy: Results of a Long-term Follow-up. Diseases of the colon and rectum. 2020;63(5):678–684.
29. Brandsma H-T, Hansson BME, Aufenacker TJ, et al. Prophylactic Mesh Placement During Formation of an End-colostomy Reduces the Rate of Parastomal Hernia: Short-term Results of the Dutch PREVENT-trial. Annals of surgery. 2017;265(4):663–669.
30. López-Cano M, Serra-Aracil X, Mora L, et al. Preventing Parastomal Hernia Using a Modified Sugarbaker Technique With Composite Mesh During Laparoscopic Abdominoperineal Resection: A Randomized Controlled Trial. Annals of surgery. 2016;264(6):923–928.
31. Odensten C, Strigård K, Rutegård J, et al. Use of Prophylactic Mesh When Creating a Colostomy Does Not Prevent Parastomal Hernia: A Randomized Controlled Trial — STOMAMESH. Annals of Surgery. 2019;269(3):427–431.
32. Prudhomme M, Fabbro-Peray P, Rullier E, et al. Meta-analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia. Annals of surgery. 2021;274(1):20–28.
33. Ringblom C, Odensten C, Strigård K, et al. No Reduction in Parastomal Hernia Rate 3 Years after Stoma Construction with Prophylactic Mesh: Three-year Follow-up Results from STOMAMESH — A Multicenter Double-blind Randomized Controlled Trial. Annals of Surgery. 2023;277(1):38–42.
34. Whittaker M, Goligher JC. A comparison of the results of extraperitoneal and intraperitoneal techniques for construction of terminal iliac colostomies. Diseases of the colon and rectum. 1976;19(4):342–344.
35. Dong L-R, Zhu Y-M, Xu Q, et al. Clinical evaluation of extraperitoneal colostomy without damaging the muscle layer of the abdominal wall. The Journal of international medical research. 2012;40(4):1410–1416.
36. Hamada M, Ozaki K, Muraoka G, et al. Permanent end-sigmoid colostomy through the extraperitoneal route prevents parastomal hernia after laparoscopic abdominoperineal resection. Diseases of the colon and rectum. 2012;55(9):963–969.
37. Leroy J, Diana M, Callari C, et al. Laparoscopic extraperitoneal colostomy in elective abdominoperineal resection for cancer: a single surgeon experience. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012;14(9):e618–22.
38. Heiying J, Yonghong D, Xiaofeng W, et al. A study of laparoscopic extraperitoneal sigmoid colostomy after abdomino-perineal resection for rectal cancer. Gastroenterology report. 2014;2(1):58–62.
39. Sjödahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma. The British journal of surgery. 1988;75(4):339–341.
40. Williams JG, Etherington R, Hayward MW, et al. Paraileostomy hernia: a clinical and radiological study. The British journal of surgery. 1990;77(12):1355–1357.
41. Etherington RJ, Williams JG, Hayward MW, et al. Demonstration of para-ileostomy herniation using computed tomography. Clinical radiology. 1990;41(5):333–336.
42. Ortiz H, Sara MJ, Armendariz P, et al. Does the frequency of paracolostomy hernias depend on the position of the colostomy in the abdominal wall? International journal of colorectal disease. 1994;9(2):65–67.
43. Leong AP, Londono-Schimmer EE, Phillips RK. Life-table analysis of stomal complications following ileostomy. The British journal of surgery. 1994;81(5):727–729.
44. Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Diseases of the colon and rectum. 1994;37(9):916–920.
45. Cingi A, Cakir T, Sever A, et al. Enterostomy site hernias: a clinical and computerized tomographic evaluation. Diseases of the colon and rectum. 2006;49(10):1559–1563.
46. Pilgrim CHC, McIntyre R, Bailey M. Prospective audit of parastomal hernia: prevalence and associated comorbidities. Diseases of the colon and rectum. 2010;53(1):71–76.
47. Hardt J, Seyfried S, Weiß C, et al. A pilot single-centre randomized trial assessing the safety and efficacy of lateral pararectus abdominis compared with transrectus abdominis muscle stoma placement in patients with temporary loop ileostomies: the PATRASTOM trial. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2016;18(2):O81-90.
Review
For citations:
Chernyshov S.V., Khilkov Yu.S., Abdullayeva N.S., Moskalev A.I. Does the parastomal hernia rate depend on the method of stoma formation? (meta-analysis and review). Koloproktologia. 2025;24(1):91-102. https://doi.org/10.33878/2073-7556-2025-24-1-91-102
Views:
443
Email this article 
