# Parastomal hernia prevention and repair in Australasia: A binational CSSANZ survey of contemporary practice

## TL;DR

A survey of surgeons in Australia and New Zealand reveals inconsistent practices in preventing and repairing parastomal hernias, with low use of prophylactic mesh and varied surgical techniques.

## Contribution

The study identifies significant variability in parastomal hernia management practices among Australasian colorectal surgeons, highlighting the need for standardized guidelines.

## Key findings

- Only 11.8% of surgeons routinely use prophylactic mesh during stoma formation.
- Surgeons preferring minimally invasive techniques more commonly use Sugarbaker repair for elective hernia repair.
- Experienced surgeons are more likely to use mesh in emergency small-bowel obstruction cases.

## Abstract

Parastomal hernia (PSH) is a debilitating long-term complication of stoma formation, often required as part of curative or palliative treatment for colorectal cancer. As a common downstream consequence of cancer surgery, PSH contributes significantly to chronic morbidity and impairs quality of life, yet practices surrounding its prevention and repair remain heterogeneous. Despite randomised evidence supporting prophylactic mesh, adoption is limited, and operative approaches to elective and emergency repair vary widely.

A cross-sectional survey of colorectal surgeons in Australia and New Zealand was conducted via the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) to assess current PSH management. The survey examined stoma creation practices, prophylactic and therapeutic mesh use, operative techniques, and responses to clinical vignettes. Subgroup analyses explored variation by surgeon seniority, practice setting, and country.

Ninety-three surgeons responded (93/365, 25.5%), including 74/93 (79.6%) from Australia and 19/93 (20.4%) from New Zealand; 79/93 (84.9%) practised in metropolitan centres and 39/93 (41.9%) had > 15 years’ experience. Routine prophylactic mesh use at stoma formation was reported by 11/93 (11.8%). For elective repair (n = 89), open access was preferred by 48/89 (53.9%) and Sugarbaker repair was the most common configuration (40/89, 44.9%). Technique selection differed by access: among surgeons favouring minimally invasive surgery (n = 41), 33/41 (80.5%) selected Sugarbaker, whereas those favouring open surgery (n = 48) more often selected keyhole (22/48, 45.8%) or retrorectus “sandwich” repair (18/48, 37.5%) (p < 0.00001). In the emergency small-bowel obstruction vignette, surgeons with > 15 years’ experience more often favoured mesh use than those with ≤ 15 years (21/39, 53.8% vs 10/50, 20.0%; p = 0.0015). Overall operative volume was low, with 65/93 (69.9%) reporting 0–5 PSH repairs per year.

PSH prevention and repair across Australasia is marked by wide variability, low uptake of prophylactic mesh, and inconsistent technique selection. Operative approach strongly influenced repair configuration, and seniority appeared to drive emergency decision-making. Addressing PSH represents an important opportunity to reduce treatment-related morbidity in patients with pelvic malignancies undergoing stoma formation.