University of Oulu

Mäkäräinen-Uhlbäck, E., Vironen, J., Falenius, V. et al. Parastomal Hernia: A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up. World J Surg 45, 1742–1749 (2021).

Parastomal hernia : a retrospective nationwide cohort study comparing different techniques with long-term follow-up

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Author: Mäkäräinen-Uhlbäck, Elisa1; Vironen, Jaana2; Falenius, Ville3;
Organizations: 1Department of Surgery, Medical Research Center, University of Oulu, Oulu University Hospital, 29, 90029 OYS, Oulu, PL, Finland
2Abdominal Center, Helsinki University Hospital, PL 8000, 00029 HUS, Helsinki, Finland
3Department of Surgery, University of Turku, PL 52, 20521, Turku, Finland
4Department of Surgery, Tampere University Hospital, PL 2000, 3352o, Tampere, Finland
5Department of Surgery, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
6Department of Surgery, Kanta-Häme Central Hospital, Ahvenistontie 20, 13530, Hämeenlinna, Finland
7Department of Surgery, Joensuu Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
8Department of Surgery, Keski-Suomi Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
9Department of Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland
10Division of Operative Care, Oulu University Hospital, PL 29, 90029 OYS, Oulu, Finland
11The Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: Springer Nature, 2021
Publish Date: 2021-06-08


Background: Parastomal hernia repair is a complex surgical procedure with high recurrence and complication rates. This retrospective nationwide cohort study presents the results of different parastomal hernia repair techniques in Finland.

Methods: All patients who underwent a primary end ostomy parastomal hernia repair in the nine participating hospitals during 2007–2017 were included in the study. The primary outcome measure was recurrence rate. Secondary outcomes were complications and re-operation rate.

Results: In total, 235 primary elective parastomal hernia repairs were performed in five university hospitals and four central hospitals in Finland during 2007–2017. The major techniques used were the Sugarbaker (38.8%), keyhole (16.3%), and sandwich techniques (15.4%). In addition, a specific intra-abdominal keyhole technique with a funnel-shaped mesh was utilized in 8.3% of the techniques; other parastomal hernia repair techniques were used in 21.3% of the cases. The median follow-up time was 39.0 months (0–146, SD 35.3). The recurrence rates after the keyhole, Sugarbaker, sandwich, specific funnel-shaped mesh, and other techniques were 35.9%, 21.5%, 13.5%, 15%, and 35.3%, respectively. The overall re-operation rate was 20.4%, while complications occurred in 26.3% of patients.

Conclusion: The recurrence rate after parastomal hernia repair is unacceptable in this nationwide cohort study. As PSH repair volumes are low, further multinational, randomized controlled trials and hernia registry data are needed to improve the results.

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Series: World journal of surgery
ISSN: 0364-2313
ISSN-E: 1432-2323
ISSN-L: 0364-2313
Volume: 45
Issue: 6
Pages: 1742 - 1749
DOI: 10.1007/s00268-021-05990-z
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open access funding provided by University of Oulu including Oulu University Hospital.. No funding was received to accomplish the PARHER study.
Copyright information: © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit