Prevention and surgical treatment of parastomal hernias
Thesis event information
Date and time of the thesis defence
Place of the thesis defence
Oulu University Hospital, Auditorium 1. Remote access: oulu.zoom.us/j/67051357437
Topic of the dissertation
Prevention and surgical treatment of parastomal hernias
Doctoral candidate
MD Elisa Mäkäräinen
Faculty and unit
University of Oulu Graduate School, Faculty of Medicine, Medical research center Oulu
Subject of study
Medicine
Opponent
Docent Heikki Huhtinen, Turku University Hospital
Custos
Professor Juha Saarnio, University of Oulu, Oulu University Hospital
Prevention and surgical treatment of parastomal hernias
Parastomal hernia (PSH) is not merely a complication but rather an inevitable consequence of a stoma, occurring in up to 50% of ostomies. However, the surgical treatment for PSH has high complication and recurrence rates. Prophylactic mesh placement at the index surgery has been used to reduce the incidence of PSH, but despite its promising early results, the significance of PSH prevention has been questioned. The aim of this thesis was to discover the long-term results of PSH prevention and the nationwide results of surgical treatment for PSH. Additionally, the thesis explored whether emergency surgery for diverticulitis is a significant risk factor for PSH.
Study I investigated the long-term efficiency and safety of the intra-abdominal keyhole technique for preventing PSH after laparoscopic abdominoperineal resection (APR) for rectal adenocarcinoma. Although the mesh lowered the PSH repair rate and the risk of stomal prolapse, the technique failed to decrease PSH incidence during long-term follow-up.
Studies II and III reported nationwide retrospective registry data for end ostomy (Study II) and ileal conduit (Study III) PSH repairs performed in nine Finnish hospitals. The results were poor, with high recurrence, complication, and reoperation rates, and the keyhole technique was associated with a significant risk of recurrence. Therefore, this technique should not be used for PSH repair.
Study IV was a systematic review of parastomal and incisional hernia incidences after emergency surgery for Hinchey III–IV diverticulitis. The review revealed that hernia incidences have been widely ignored in the literature.
To conclude, the results of both the prevention and surgical treatment of PSH were unsatisfactory. Therefore, future studies should find better solutions and new techniques to prevent and treat PSH. Further studies on emergency surgery for diverticulitis should pay attention to hernia incidence and its prevention.
Remote access: https://oulu.zoom.us/j/67051357437?pwd=ZVd5dS9kMlRPZlVDeXBZbzBEYXNOUT09#success
Study I investigated the long-term efficiency and safety of the intra-abdominal keyhole technique for preventing PSH after laparoscopic abdominoperineal resection (APR) for rectal adenocarcinoma. Although the mesh lowered the PSH repair rate and the risk of stomal prolapse, the technique failed to decrease PSH incidence during long-term follow-up.
Studies II and III reported nationwide retrospective registry data for end ostomy (Study II) and ileal conduit (Study III) PSH repairs performed in nine Finnish hospitals. The results were poor, with high recurrence, complication, and reoperation rates, and the keyhole technique was associated with a significant risk of recurrence. Therefore, this technique should not be used for PSH repair.
Study IV was a systematic review of parastomal and incisional hernia incidences after emergency surgery for Hinchey III–IV diverticulitis. The review revealed that hernia incidences have been widely ignored in the literature.
To conclude, the results of both the prevention and surgical treatment of PSH were unsatisfactory. Therefore, future studies should find better solutions and new techniques to prevent and treat PSH. Further studies on emergency surgery for diverticulitis should pay attention to hernia incidence and its prevention.
Remote access: https://oulu.zoom.us/j/67051357437?pwd=ZVd5dS9kMlRPZlVDeXBZbzBEYXNOUT09#success
Last updated: 1.3.2023