Skip to main content
SpringerLink
Log in

Parastomal and incisional hernia following laparoscopic/open abdominoperineal resection: is there a real difference?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The aim of the present study was to explore incidence and severity of parastomal hernia (PSH) formation during the first 2 years after open/laparoscopic abdominoperineal resection (APR).

Methods

This was a retrospective cohort study conducted in a single institution. All patients who underwent laparoscopic/open APR for low rectal cancer within a 10-year study period were assessed for study eligibility.

Results

In total, 148 patients were included in the study (97 patients after laparoscopic APR; 51 patients after open APR). There were no statistically significant differences between study subgroups regarding demographic and clinical features. The incidence of PSH detected by physical examination was significantly higher in patients after laparoscopic APR 1 year after the surgery (50.5% vs. 19.6%, p < 0.001) and 2 years after the surgery (57.7% vs. 29.4%, p = 0.001). The incidence of radiologically detected PSH was significantly higher in laparoscopically operated patients after 1 year (58.7% vs. 35.3%, p = 0.007) and after 2 years (61.8% vs. 37.2%, p = 0.004). The mean diameter of PSH was similar in both study subgroups. The incidence of incisional hernia was significantly higher in patients who underwent open APR after 1 year (25.5% vs. 7.2%, p = 0.002) and after 2 years (31.3% vs. 7.2%, p < 0.001).

Conclusions

The risk of PSH development after laparoscopic APR appears to be significantly higher in comparison with patients undergoing open APR. Higher incidence of PSH should be considered a potential disadvantage of minimally invasive approach to patients with low rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Londono-Schimmer EE, Leaong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37(9):916–920

    Article  CAS  PubMed  Google Scholar 

  2. Gillern S, Bleier JI (2014) Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials. Clin Colon Rectal Surg 27:162–171

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hansson BME, Morales-Conde S, Mussack T, Valdes J, Muysoms FE, Bleichrodt RP (2013) The laparoscopic modified Sugarbaker technique is safe and has a low recurrence rate: a multicenter cohort study. Surg Endosc 27:494–500

    Article  CAS  PubMed  Google Scholar 

  4. Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90(7):784–793

    Article  CAS  PubMed  Google Scholar 

  5. O’Neill CH, Borrazzo EC, Hyman NH (2015) Parastomal hernia repair. J Gastrointest Surg 19:766–769

    Article  PubMed  Google Scholar 

  6. Cheung MT, Chia NH, Chiu WY (2001) Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 44:266–271

    Article  CAS  PubMed  Google Scholar 

  7. Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M (2011) Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 148:e435–e441

    Article  CAS  PubMed  Google Scholar 

  8. Asif A, Ruiz M. Yetasook A, Denham W, Linn J, Carbray J, Ujiki MB (2012) Laparoscopic modified Sugerbaker technique results in superior recurrence rate. Surg Endosc 26:3430–3434

    Article  PubMed  Google Scholar 

  9. Kald A, Juul KN, Hjortsvang H, Sjodahl RI (2008) Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 43:627–633

    Article  PubMed  Google Scholar 

  10. Ihnát P, Guňková P, Peteja M, Vávra P, Pelikán A, Zonča P (2016) Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc 30(11):4809–4816

    Article  PubMed  Google Scholar 

  11. Funahashi K, Suzuki R, Nagashima Y, Matsuda S, Koike J, Shiokawa H, Ushigome M, Arai K, Kaneko T, Kurihara A, Kaneko H (2014) Risk factors for parastomal hernia in Japanese patients with permanent colostomy. Surg Today 44:1465–1469

    Article  PubMed  Google Scholar 

  12. Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, Breukink S (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200

    Google Scholar 

  13. Tan WJ, Chew MH, Dharmawan AR, Singh M, Acharyya S, Loi CT, Tanq CL (2016) Critical appraisal of laparoscopic vs open rectal cancer surgery. World J Gastrointest Surg 8(6):452

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ng SS, Lee JF, Yiu RY, Li JC, Hon SS, Mak TW, Leung WW, Leunq KL (2014) Long-term oncologic outcomes of laparoscopic versus open surgery for rectal cancer: a pooled analysis of 3 randomized controlled trials. Ann Surg 259(1):139–147

    Article  PubMed  Google Scholar 

  15. Agha A, Benseler V, Hornung M, Gerken M, Iesalnieks I, Fürst A, Anthuber M, Jauch KW, Schlitt HJ (2014) Long-term oncologic outcome after laparoscopic surgery for rectal cancer. Surg Endosc 28(4):1119–1125

    Article  PubMed  Google Scholar 

  16. Ihnát P, Martínek L, Mitták M, Vávra P, Ihnát Rudinská L, Zonča P (2014) Quality of life after laparoscopic and open resection of colorectal cancer. Dig Surg 31(3):161–168

    Article  PubMed  Google Scholar 

  17. Randall J, Lord B, Fulham J, Soin B (2012) Parastomal hernias as the predominant stoma complication after laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 22(5):420–423

    Article  PubMed  Google Scholar 

  18. Carne PW, Frye JN, Robertson GM, Frizelle FA (2003) Parastomal hernia following minimally invasive stoma formation. ANZ J Surg 73(10):843–845

    Article  PubMed  Google Scholar 

  19. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  CAS  PubMed  Google Scholar 

  20. Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S (2009) The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 11:173–177

    Article  CAS  PubMed  Google Scholar 

  21. Hotouras A, Murphy J, Thaha M, Chan CL (2013) The persistent challenge of parastomal herniation: a review of the literature and future developments. Colorectal Dis 15(5):e202–e214

    Article  CAS  PubMed  Google Scholar 

  22. Malik T, Lee MJ, Harikrishnan AB (2018) The incidence of soma related morbidity—a systematic review of randomised controlled trials. Ann R Coll Surg Engl 100(7):501–508. https://doi.org/10.1308/rcsann.2018.0126 [Epub ahead of print]

    Article  PubMed  PubMed Central  Google Scholar 

  23. Petersson J, Koedam TW, Bonjer HJ, Andersson J, Angenete E, Bock D, Cuesta MA, Deijen CL, Furst A, Lacz AM, Rosenberg J, Haglind E, COlorectal cancer Laparoscopic or Open Resection (COLOR) II Study Group (2018) Bowel obstruction and ventral hernia after laparoscopic versus open surgery for rectal cancer in a randomized trial (COLOR II). Ann Surg. https://doi.org/10.1097/SLA.0000000000002790 [Epub ahead of print]

    Article  Google Scholar 

  24. Aguina CT, Iannuzzi JC, Probst CP, Kelly KN, Noyes K, Fleming FJ, Monson JRT (2014) Parastomal hernia: a growing problem with new solutions. Dig Surg 31:366–376

    Article  Google Scholar 

  25. Ihnát P, Ihnát Rudinská L, Zonča P (2014) Radiofrequency energy in surgery: state of the art. Surg Today 44(6):985–991

    Article  PubMed  Google Scholar 

  26. Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255:685–695

    Article  PubMed  Google Scholar 

  27. Slater NJ, hansson BME, Buyne OR, Hendriks T, Bleichrodt RP (2011) Repair of parastomal hernias with biological grafts: a systematic review of the literature. J Gastrointest Surg 15:1252–1258

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hansson BME (2013) Parastomal hernia: treatment and prevention 2013; where do we go from here? Colorectal Dis 15:1467–1470

    Article  CAS  PubMed  Google Scholar 

  29. Cingi A, Carik T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563

    Article  PubMed  Google Scholar 

  30. Janson AR, Janes A, Israelsson LA (2010) Laparoscopic stoma formation with a prophylactic prosthetic mesh. Hernia 14:495–498

    Article  CAS  PubMed  Google Scholar 

  31. Jones HG, Rees M, Aboumarzouk OM, Brown J, Cragg J, Billings P, Carter B, Chandran P (2018) Prosthetic mesh placement for the prevention of parastomal herniation. Cochrane Database Syst Rev 7:CD008905

    PubMed  Google Scholar 

  32. Findlay JM, Wood CPJ, Cunninham C (2018) Prophylactic mesh reinforcement of stomas: a cost-effectiveness meta-analysis of randomised controlled trials. Tech Coloproctol. https://doi.org/10.1007/s10151-018-1774-5 [Epub ahead of print]

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic

    Peter Ihnát, Lubomír Tulinský & Igor Penka

  2. Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic

    Peter Ihnát, Lubomír Tulinský & Igor Penka

  3. Department of Radiology, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic

    Tomáš Jonszta & Pavel Koscielnik

  4. Department of Forensic Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic

    Lucia Ihnát Rudinská

Authors
  1. Peter Ihnát
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lubomír Tulinský
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomáš Jonszta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pavel Koscielnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lucia Ihnát Rudinská
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Igor Penka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Ihnát.

Ethics declarations

Disclosures

Peter Ihnát, Lubomír Tulinský, Tomáš Jonszta, Pavel Koscielnik, Lucia Ihnát Rudinská, and Igor Penka have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ihnát, P., Tulinský, L., Jonszta, T. et al. Parastomal and incisional hernia following laparoscopic/open abdominoperineal resection: is there a real difference?. Surg Endosc 33, 1789–1794 (2019). https://doi.org/10.1007/s00464-018-6453-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6453-0

Keywords

Search

Navigation