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Parastomal Hernia Repair - The Unkindest Cut Of All?
*Neil GIbson, Steven Schechter, Nishit Shah
Brown University, Providence, RI
Objective: Parastomal hernia is a frequent complication following colostomy creation. Repair of hernias in this setting can be a challenging problem with potentially high perioperative morbidity. This study sought to analyze outcomes following repair of parastomal hernias and determine any surgical risk factors.
Design: Retrospective analysis of all patients who had undergone parastomal hernia repair, focusing on comparing outcomes after both elective and emergency surgery, as well use of mesh versus primary repair.
Setting: Tertiary care hospital.
Patients: All patients with parastomal hernia repair selected by CPT code 44346 from 2002-2012.
Interventions: None.
Main Outcome Measures: 30-day mortality and morbidity, including surgical site infections (SSI).
Results: 45 patients underwent parastomal hernia repair (mean age - 72, males - 27%). Fourteen (31%) patients underwent emergency surgery. Thirteen (29%) underwent local, fascial repairs. Mesh was used in 27 patients (60 % - 14 biologic, 13 prosthetic). There was no mortality. Complications occurred in 18 (40%) patients. There were seven SSI, including one fascial dehiscence. Two patients developed enterocutaneous fistulas. There was no statistically significant difference in morbidity between emergency and elective surgery, nor between elderly and non-elderly (> 70y vs < 70y). Furthermore, use of mesh was not associated with an increase in infectious complications (56%, mesh vs. 44% no mesh, p - not significant).
Conclusions: Parastomal hernia repair is associated with a high complication rate. However, in this study, this morbidity was not influenced by the age of the patient, nor emergency surgery. Furthermore, use of mesh also did not adversely affect SSI. These results suggest that though parastomal hernia repair is associated with increased complications, traditional surgical risk factors do not contribute further to this morbidity.
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