Operative management of recurrent parastomal hernias after transversus abdominis release: a single-center experience

TL;DR

This study examines the surgical management of recurrent parastomal hernias after a specific repair technique and finds that most patients eventually need a redo repair.

Contribution

The paper provides insights into the outcomes of managing recurrent parastomal hernias after transversus abdominis release, a topic with limited existing data.

Findings

Open redo retromuscular repair was the most common and effective treatment for recurrence.

The Sugarbaker mesh orientation had the lowest recurrence rate at one year.

Most patients ultimately required an open redo retromuscular repair for definitive treatment.

Abstract

Parastomal hernia recurrences after repair utilizing a transversus abdominis release (TAR) with retromuscular mesh presents a challenging clinical situation with little data available for guidance. This descriptive study characterizes our center’s experiences with operative management of recurrent parastomal hernias after TAR and associated outcomes.

Open parastomal hernia repairs with TAR performed at our institution from August 2014 through August 2023 were identified via the Abdominal Core Health Quality Collaborative (ACHQC) database and reviewed to assess for instances of recurrence and reoperation. Electronic medical records were reviewed to confirm supplement operative and follow-up details. Hernia characteristics, operative characteristics, and outcomes of cases for these recurrent cases were abstracted and analyzed.

Following 172 open parastomal hernia repairs with TAR, 63 recurrences were identified, and 29 patients underwent 39 subsequent operations, as five patients required at least two reoperations for recurrence. Open redo retromuscular repair (25/39, 64%) was the most utilized operation, the most frequent final operation (23/29, 79%) and the open redo retromuscular Sugarbaker mesh orientation featured the lowest recurrence rate of ~ 5% at 1 year. All cases of primary repair or re-siting the stoma through previous retromuscular mesh required an additional operation for recurrence. Of the six patients (21%) who have avoided an open redo-RM repair, three have had a laparoscopic Sugarbaker, and two have had an open onlay.

While all utilized techniques demonstrate the ability to temporize patients, most patients with parastomal hernia recurrence after a TAR ultimately require an open redo retromuscular repair which appears to be the most definitive option.

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