Elisa Mäkäräinen-Uhlbäck1, Jaana Vironen2, Ville Falenius3, Pia Nordström4, Anu Välikoski4, Jyrki Kössi5, Aristotelis Kechagias6, Maija Kalliala7, Anne Mattila8, Tuomo Rantanen9, Tom Scheinin2, Pasi Ohtonen10,11, Tero Rautio12. 1. Department of Surgery, Medical Research Center, University of Oulu, Oulu University Hospital, 29, 90029 OYS, Oulu, PL, Finland. elisa.makarainen-uhlback@ppshp.fi. 2. Abdominal Center, Helsinki University Hospital, PL 8000, 00029 HUS, Helsinki, Finland. 3. Department of Surgery, University of Turku, PL 52, 20521, Turku, Finland. 4. Department of Surgery, Tampere University Hospital, PL 2000, 3352o, Tampere, Finland. 5. Department of Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland. 6. Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland. 7. Department of Surgery, Joensuu Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland. 8. Department of Surgery, Keski-Suomi Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland. 9. Department of Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. 10. Division of Operative Care, Oulu University Hospital, PL 29, 90029 OYS, Oulu, Finland. 11. The Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland. 12. Department of Surgery, Medical Research Center, University of Oulu, Oulu University Hospital, 29, 90029 OYS, Oulu, PL, Finland.
Abstract
BACKGROUND: Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. METHODS: All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007-2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. RESULTS: In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007-2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0-146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. CONCLUSION: The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.
BACKGROUND:Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland. METHODS: All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007-2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate. RESULTS: In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007-2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0-146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients. CONCLUSION: The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.
Authors: Sven M van Dijk; Lucas Timmermans; Eva B Deerenberg; Bas Lamme; Gert-Jan Kleinrensink; Johannes Jeekel; Johan F Lange Journal: World J Surg Date: 2015-10 Impact factor: 3.352
Authors: Gernot Köhler; Franz Mayer; Helwig Wundsam; Rudolf Schrittwieser; Klaus Emmanuel; Michael Lechner Journal: World J Surg Date: 2015-11 Impact factor: 3.352