title: Surgical techniques for parastomal hernia repair: a systematic review of the literature.
abstract: BACKGROUND
  Parastomal hernias are a frequent complication of enterostomies that require surgical treatment in approximately half of patients. This systematic review aimed to evaluate and compare the safety and effectiveness of the surgical techniques available for parastomal hernia repair.
  
  
  METHODS
  Systematic review was performed in accordance with PRISMA. Assessment of methodological quality and selection of studies of parastomal hernia repair was done with a modified MINORS. Subgroups were formed for each surgical technique. Primary outcome was recurrence after at least 1-year follow-up. Secondary outcomes were mortality and postoperative morbidity. Outcomes were analyzed using weighted pooled proportions and logistic regression.
  
  
  RESULTS
  Thirty studies were included with the majority retrospective. Suture repair resulted in a significantly increased recurrence rate when compared with mesh repair (odds ratio [OR] 8.9, 95% confidence interval [CI] 5.2-15.1; P < 0.0001). Recurrence rates for mesh repair ranged from 6.9% to 17% and did not differ significantly. In the laparoscopic repair group, the Sugarbaker technique had less recurrences than the keyhole technique (OR 2.3, 95% CI 1.2-4.6; P = 0.016). Morbidity did not differ between techniques. The overall rate of mesh infections was low (3%, 95% CI 2) and comparable for each type of mesh repair.
  
  
  CONCLUSIONS
  Suture repair of parastomal hernia should be abandoned because of increased recurrence rates. The use of mesh in parastomal hernia repair significantly reduces recurrence rates and is safe with a low overall rate of mesh infection. In laparoscopic repair, the Sugarbaker technique is superior over the keyhole technique showing fewer recurrences.
authors.affiliation: Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands. b.hansson@cwz.nl
authors.forename: Birgitta M E
authors.initials: BM
authors.lastname: Hansson
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Slater
authors.forename: Arjan Schouten
authors.initials: AS
authors.lastname: van der Velden
authors.forename: Hans M M
authors.initials: HM
authors.lastname: Groenewoud
authors.forename: Otmar R
authors.initials: OR
authors.lastname: Buyne
authors.forename: Ignace H J T
authors.initials: IH
authors.lastname: de Hingh
authors.forename: Rob P
authors.initials: RP
authors.lastname: Bleichrodt
mesh_terms: D004766:Enterostomy; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome