Clinical Scorecard: Parastomal Hernia and Stomal Prolapse After Open and Minimally Invasive Surgery: A Systematic Review

At a Glance

Key Highlights

• The review evaluates reported incidence of parastomal hernia and subcutaneous or external stomal prolapse after open versus minimally invasive resection; comparative outcome results are not provided in the supplied text.
• The review included eligible studies published in the preceding 15 years and available through April 2, 2025.
• Parastomal hernia incidence has been reported to exceed 30% after one year and reach 58%, varying with patient- and stoma-related factors.
• Reported pooled incidence estimates for external stomal prolapse range from 2% to 26%; whether surgical approach affects its occurrence remains unclear.
• Heterogeneous definitions and diagnostic criteria limit comparisons and reliable distinction between parastomal hernia and subcutaneous stomal prolapse.

Guideline-Based Recommendations

Diagnosis

• The source states that peristomal bulging is nonspecific and may indicate parastomal hernia, subcutaneous stomal prolapse, or neither; reliable differentiation requires cross-sectional imaging.
• The source reports that EHS guidelines note no universally validated classification system for stoma complications.

Management

• The source describes varied indications and highly heterogeneous approaches to parastomal hernia treatment, with moderate outcomes overall.
• Studies of prophylactic mesh and extraperitoneal stoma construction were excluded; the review does not provide a treatment recommendation for these approaches.

Monitoring & Follow-up

• Eligible studies were required to include at least 12 months of follow-up.
• The review recorded whether parastomal hernia diagnosis relied on radiological imaging, including CT.

Risks

• The source identifies obesity, older age, and stoma-aperture size as established risk factors for parastomal hernia.
• The source states that stoma routing, abdominal wall defect dimensions, and stoma placement relative to the rectus muscle may affect parastomal hernia development.
• Evidence on whether laparoscopic or robotic surgery is associated with greater parastomal hernia risk is inconclusive.

Patient & Prescribing Data

Adults undergoing intestinal resection, including multivisceral resection, with definitive ileostomy or colostomy; eligible studies required at least 12 months of follow-up.

The review compares open with laparoscopic or robotic resection. It excludes procedures involving prophylactic mesh or an extraperitoneal stoma route; the supplied article text does not report comparative outcome results.

Clinical Best Practices

• The source states that peristomal bulging is nonspecific and that cross-sectional imaging is required for reliable differentiation among parastomal hernia, subcutaneous prolapse, and bulging without either condition.
• The source reports that varying definitions and diagnostic criteria for stoma complications restrict comparisons between studies.
• The source identifies obesity, older age, aperture size, routing, defect dimensions, and placement relative to the rectus muscle as factors associated with parastomal hernia development.

Related Resources & Content

• European Hernia Society guidelines on prevention and treatment of parastomal hernias
• PRISMA 2020 Statement
• PROSPERO registration CRD420251026395