Advanced

European Hernia Society guidelines on prevention and treatment of parastomal hernias

Antoniou, S. A.; Agresta, F.; Garcia Alamino, J. M.; Berger, D.; Berrevoet, F.; Brandsma, H. T.; Bury, K.; Conze, J.; Cuccurullo, D. and Dietz, U. A., et al. (2017) In Hernia
Abstract

Background: International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. Methods: The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was... (More)

Background: International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. Methods: The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. Results: End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. Conclusion: An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Ostomy, Parastomal hernia, Prevention, Recurrence, Stoma, Treatment
in
Hernia
pages
16 pages
publisher
Springer
external identifiers
  • scopus:85033561639
ISSN
1265-4906
DOI
10.1007/s10029-017-1697-5
language
English
LU publication?
no
id
f4b309e3-5b60-4ea6-a444-55d1bf924774
date added to LUP
2017-11-22 09:45:31
date last changed
2018-01-07 12:26:28
@article{f4b309e3-5b60-4ea6-a444-55d1bf924774,
  abstract     = {<p>Background: International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. Methods: The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. Results: End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. Conclusion: An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.</p>},
  author       = {Antoniou, S. A. and Agresta, F. and Garcia Alamino, J. M. and Berger, D. and Berrevoet, F. and Brandsma, H. T. and Bury, K. and Conze, J. and Cuccurullo, D. and Dietz, U. A. and Fortelny, R. H. and Frei-Lanter, C. and Hansson, B. and Helgstrand, F. and Hotouras, A. and Jänes, A. and Kroese, L. F. and Lambrecht, J. R. and Kyle-Leinhase, I. and López-Cano, M. and Maggiori, L. and Mandalà, V. and Miserez, M. and Montgomery, A. and Morales-Conde, S. and Prudhomme, M. and Rautio, T. and Smart, N. and Śmietański, M. and Szczepkowski, M. and Stabilini, C. and Muysoms, F. E.},
  issn         = {1265-4906},
  keyword      = {Ostomy,Parastomal hernia,Prevention,Recurrence,Stoma,Treatment},
  language     = {eng},
  month        = {11},
  pages        = {16},
  publisher    = {Springer},
  series       = {Hernia},
  title        = {European Hernia Society guidelines on prevention and treatment of parastomal hernias},
  url          = {http://dx.doi.org/10.1007/s10029-017-1697-5},
  year         = {2017},
}