Surgery · 2 h ago
Review finds higher parastomal hernia rates after minimally invasive resection
A systematic review and meta-analysis of six studies involving 1,480 patients compared parastomal hernia after open versus minimally invasive intestinal resection with definitive stoma formation. Hernia rates trended higher after minimally invasive surgery, but the authors rated the evidence certainty very low.
- Six studies included 1,480 patients with definitive stomas.
- Clinical hernia risk was higher after minimally invasive surgery.
- Evidence certainty was rated very low.
- Subcutaneous prolapse was not reported as a distinct outcome.
Parastomal hernia is a long-term complication after stoma formation. This systematic review and meta-analysis included studies published in the previous 15 years that followed patients for more than 12 months after intestinal resection with a definitive ileostomy or colostomy. Six studies met the criteria: one randomised trial and five observational studies, with 1,480 patients in total (731 treated with open surgery and 749 with laparoscopic surgery). The primary outcome was parastomal hernia incidence; robotic procedures were also eligible for inclusion.
All six studies reported parastomal hernia. The pooled relative risk after minimally invasive versus open surgery was 1.89 for clinically assessed hernias (95% CI 1.39–2.58) and 1.70 for radiologically assessed hernias (95% CI 0.89–3.28). No included study reported subcutaneous prolapse as a distinct outcome; one reported external stomal prolapse.
The authors conclude that minimally invasive resection may be associated with more parastomal hernias, but emphasize that the evidence is of very low certainty. The findings do not establish that surgical approach causes the difference. The review also highlights inconsistent recognition of subcutaneous prolapse, which may complicate comparisons and clinical classification. The review was registered with PROSPERO (CRD420251026395).
In practice
For patients undergoing intestinal resection with definitive ileostomy or colostomy, this review found higher clinically assessed parastomal hernia rates after minimally invasive than open surgery, while the radiological estimate was imprecise. The evidence comes from only six studies, including one randomised trial, and was rated very low certainty; it does not establish a causal effect or support changing operative approach on its own. Subcutaneous prolapse was not separately reported in any included study.
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Surgical Endoscopy: Incidence of parastomal hernia after open versus minimally invasive surgery: a comparative systematic review ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.