Abstract
A parastomal hernia (PSH) is the most common complication after stoma creation, occurring in more than half of patients two years after surgery. Obesity is a major risk factor for the development of a PSH, and its incidence is expected to increase in the future. Although no surgical technique is strongly recommended to prevent PSH development, the creation of a stoma through a retroperitoneal route and prophylactic mesh placement at the time of stoma construction have been considered potentially effective.
Most PSH cases remain asymptomatic and are managed conservatively; however, surgical intervention is absolutely indicated in emergency cases with acute irreducibility or strangulation. In contrast, symptoms such as pain, difficulty with stoma appliance adherence, and poor cosmesis constitute relative indications for surgery.
Primary fascial closure alone is not recommended due to its high recurrence rate, and meshbased repair techniques should be used. Common mesh repair approaches include the onlay method, retromuscular placement, and the intraperitoneal onlay mesh (IPOM) technique. Of the IPOM repairs, the keyhole and Sugarbaker techniques are the principal options. A metaanalysis of laparoscopic IPOM procedures reported recurrence rates of 24.1％ for the keyhole method and 9％ for the Sugarbaker method, indicating a significantly higher recurrence with the former. Thus, the laparoscopic keyhole technique is not currently recommended.
