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Hernia. 2018 Feb;22(1):183-198. doi: 10.1007/s10029-017-1697-5. Epub 2017 Nov 13.

European Hernia Society guidelines on prevention and treatment of parastomal hernias.

Author information

1
Department of General Surgery, University Hospital of Herakion, Crete, Greece. stavros.antoniou@hotmail.com.
2
Department of General Surgery, ULSS19 del Veneto, Adria, RO, Italy.
3
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
4
Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden, Germany.
5
Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium.
6
Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK.
7
Department Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland.
8
Herniacenter Dr. Muschaweck/Dr. Conze, Munich, Germany.
9
Herniacenter Dr. Muschaweck/Dr. Conze, London, UK.
10
Department of General, Visceral and Transplant Surgery, University Hospital, RWTH Aachen University, Aachen, Germany.
11
Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera dei Colli, Naples, Italy.
12
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany.
13
Certified Hernia Center, Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria.
14
Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
15
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
16
Department of Surgery, Zealand University Hospital, Køge, Denmark.
17
National Bowel Research Centre, The Royal London Hospital, London, United Kingdom.
18
Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.
19
Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
20
Surgical Department, Innlandet Hospital Trust, Gjøvik, Norway.
21
Department of Surgery, Maria Middelares Hospital, Ghent, Belgium.
22
Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
23
Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
24
Department of General Surgery, Buccheri La Ferla Hospital, Palermo, Italy.
25
Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
26
Department of Surgery, Skåne University Hospital, Malmö, Sweden.
27
University Hospital Virgen del Rocío, Sevilla, Spain.
28
Digestive Surgery Department, CHU Nîmes, Nîmes, France.
29
Department of Surgery, Division of Gastroenterology, Medical Research Center, Oulu University Hospital, Oulu, Finland.
30
Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, UK.
31
2nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland.
32
Department of General Surgery and Hernia Centre, District Hospital in Puck, Puck, Poland.
33
Department of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland.
34
Clinical Department of General and Colorectal Surgery, Bielanski Hospital, Warsaw, Poland.
35
Department of Surgery, University of Genoa, Genoa, Italy.

Abstract

BACKGROUND:

International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project.

METHODS:

The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants.

RESULTS:

End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed.

CONCLUSION:

An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.

KEYWORDS:

Ostomy; Parastomal hernia; Prevention; Recurrence; Stoma; Treatment

PMID:
29134456
DOI:
10.1007/s10029-017-1697-5
[Indexed for MEDLINE]

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