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Berger. Mini-invasive Surg 2023;7:24 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.30

Review Open Access

Perspectives of prevention and treatment of

parastomal hernia-what do we really know and
where should we go?

Dieter Berger

Spital Männedorf, Asylstrasse 10, Männedorf CH-8708, Switzerland.
Correspondence to: Prof. Dieter Berger, Attending Surgeon, Spital Männedorf, Asylstrasse 10, Männedorf CH-8708,
Switzerland. E-mail: dieter.berger@hin.ch
How to cite this article: Berger D. Perspectives of prevention and treatment of parastomal hernia-what do we really know and
where should we go? Mini-invasive Surg 2023;7:24. https://dx.doi.org/10.20517/2574-1225.2023.30
Received: 30 Mar 2023 First decision: 12 May 2023 Revised: 14 Jun 2023 Accepted: 25 Jun 2023 Published: 29 Jun 2023

Academic Editors: Luca Gordini, R. Fortelny Copy Editor: Dan Zhang Production Editor: Dan Zhang

Abstract
Parastomal hernia is a frequent complication after ostomy formation, causing a significant reduction of the quality
of life of patients. In contrast to surgical dogmas dealing with the surgical technique of ostomy formation, mesh-
based prophylaxis of parastomal hernia seemed to be effective, leading to the strong recommendation in the
European Hernia Society(EHS) guidelines. More recent studies do not favor prophylaxis of parastomal hernia
anymore, mainly due to the lack of clearly differentiating the techniques. The mostly used keyhole technique (flat
mesh) cannot be equated with the “chimney technique” (3-dimensional mesh) that can be easily performed
laparoscopically. Very recent results of the Finnish Randomized Study showed a dramatic reduction of parastomal
hernia using the chimney technique. Concerning therapy of parastomal hernia, the chimney technique was also
revealed to be effective. The laparoscopic “sandwich technique” should also be used therapeutically with very
promising mid- and long-term results and seems to be superior to any other approaches. In a conclusion,
investigating the prevention of parastomal hernia should clearly differentiate between the keyhole and chimney
techniques and adopt strict technical standardization. Therapy of parastomal hernia should be based on the most
effective sandwich or the chimney technique in specialized centers, according to recent registry results. Both
techniques are based on the intraperitoneal placement of meshes requiring 3-dimensionality or the possibility of
overlapping two meshes. Up to now, these requirements are only fulfilled by meshes made by polyvinylidene
fluoride.

Keywords: Parastomal hernia, repair, prevention, surgical technique, mesh

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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