Prophylactic Approaches for Parastomal Hernia Formation During Laparoscopic Creation of Permanent End Stomas: Rationale, Techniques, and Outcomes

Parastomal hernias are a frequent occurrence after colorectal resections with creation of an ostomy, with significant impact on patient function and quality of life. A number of surgical procedures are available to treat this condition with variable success rates. Because of the difficulties to achieve consistent and long-lasting results with parastomal hernia repair, surgeons have increasingly focused on surgical strategies to reduce the risk of incidence of parastomal hernias at the time of stoma creation. Prophylactic mesh has been used for over 30 years with mixed results, which often depend on patient-related, stoma-related, and technical factors. This chapter will review the various techniques used for parastomal hernia prevention including extraperitoneal stoma creation and prophylactic mesh placement, as well as short- and long-term outcomes based on review of the best published evidence.