Parastomal Hernia: I have some comments…
Posted in Lectures on 19 June 2018
Mr Neil Smart
MBBS (Hons) PhD FRCSEd MFMLM
Consultant Colorectal Surgeon
Royal Devon & Exeter Hospital
Parastomal hernia remains a common complication after abdominal surgery with stoma formation. The 2017 European Hernia Society Guidelines show that there are many variations on how to create a stoma, with an enormous range of additional steps. However, the optimal technique for stoma creation remains unclear, and most importantly, there is significant heterogeneity in its performance from center to center.
Does a prophylactic mesh during stoma creation (index surgery) prevent parastomal hernia? There is high quality evidence supporting this fact. Moreover, the conclusion of well-designed reviews of the most important trials is that prophylactic mesh should be considered in several occasions. However, there is a high degree of skepticism regarding mesh placement, mainly because it is believed that mesh contraction may cause a buttonhole hernia and therefore an intestinal obstruction. The feeling that there has been an underreporting of adverse events does not help either.
In this lecture, Dr. Neil Smart provides an update on the importance of these concepts. The role of prophylactic meshes, how to design good studies such as the CIPHER trial, and which should be the appropriate outcomes are discussed.