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Laparoscopic Parastomal Hernia Repair Delays Recurrence Relative to Open Repair

Patrick Keller, BS, Margaret A Plymale, DNP, RN, You Wei Lin, BS, Daniel L Davenport, PhD, John S Roth, MD, FACS. University of Kentucky

Introduction: Parastomal hernia is a common problem with frequent recurrences. Mesh repair is widely accepted to be superior to non-mesh repair, yet the most favorable surgical approach is a subject of continued debate. The aim of this study was to compare the clinical outcomes of open versus laparoscopic parastomal hernia repair (PHR).

Methods: An IRB-approved retrospective review of parastomal hernia repairs performed between 2009 and 2017 by a single surgeon at an academic medical center was conducted. All PHR were included. Patients were categorized as either laparoscopic parastomal hernia repair (LPHR) or open parastomal hernia repair (OPHR) based upon surgical approach.  Patient demographics, preoperative characteristics, operative details, and clinical outcomes were compared. The longevity of repair was measured using Kaplan-Meier method and adjusted Cox proportional hazards regression for patients with at least 1 year of follow-up.

Results: 62 patients underwent PHR (28 LPHR, 34 OPHR) with an average age of 61 years.  Overall 65% of patients were obese, 80% ASA class III or higher, 15% active smokers, 27% diabetes, 23% COPD, 66% cancer and 2% with CAD. Patient age, gender, BMI, ASA Class, and comorbidity status were similar between OPHR and LPHR. More OPHR were contaminated (88% vs 12%, p< .001) or recurrent (56% vs 25%, p= .006) than LPHR. Stoma re-siting was more common in OPHR (29% vs 7%, p=.050). OPHR resulted in more wound complications (53% vs 25%, p = .038). Non-wound complications were similar between OPHR and LPHR (53% vs 32%, p= .127). 30-day return to OR (3.6% vs 9%, p=.620) and 30-day readmission (14% vs 21%, p=.740) were similar. OR time and hospital length of stay were less with LPHR (3 days vs. 7 days, p<.001).  Median follow-up was 775 days and 226 days for LPHR and OPHR, respectively. After adjustment for prior hernia repair, risk of recurrence was higher for OPHR (Hazard ratio= 3.1, log-rank p= .058).

Conclusions: Open repair of parastomal hernia is associated with longer operative duration, increased length of stay, more short-term complications and earlier recurrences than laparoscopic repair. Comparison of longevity of laparoscopic parastomal repairs to that of commonly used open repairs using Kaplan-Meier method is unique to this study. Further study is warranted to better understand methods of parastomal hernia repair associated with fewer complications and increased durability.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94642

Program Number: S100

Presentation Session: Inquinal and Ventral Hernia

Presentation Type: Podium

57

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