BACKGROUND: The aim of the present study was to explore incidence and severity of parastomal hernia (PSH) formation during the first 2 years after open/laparoscopic abdominoperineal resection (APR). METHODS: This was a retrospective cohort study conducted in a single institution. All patients who underwent laparoscopic/open APR for low rectal cancer within a 10-year study period were assessed for study eligibility. RESULTS: In total, 148 patients were included in the study (97 patients after laparoscopic APR; 51 patients after open APR). There were no statistically significant differences between study subgroups regarding demographic and clinical features. The incidence of PSH detected by physical examination was significantly higher in patients after laparoscopic APR 1 year after the surgery (50.5% vs. 19.6%, p < 0.001) and 2 years after the surgery (57.7% vs. 29.4%, p = 0.001). The incidence of radiologically detected PSH was significantly higher in laparoscopically operated patients after 1 year (58.7% vs. 35.3%, p = 0.007) and after 2 years (61.8% vs. 37.2%, p = 0.004). The mean diameter of PSH was similar in both study subgroups. The incidence of incisional hernia was significantly higher in patients who underwent open APR after 1 year (25.5% vs. 7.2%, p = 0.002) and after 2 years (31.3% vs. 7.2%, p < 0.001). CONCLUSIONS: The risk of PSH development after laparoscopic APR appears to be significantly higher in comparison with patients undergoing open APR. Higher incidence of PSH should be considered a potential disadvantage of minimally invasive approach to patients with low rectal cancer.

Department of Forensic Medicine University Hospital Ostrava 17 listopadu 1790 708 52 Ostrava Czech Republic

Department of Radiology University Hospital Ostrava 17 listopadu 1790 708 52 Ostrava Czech Republic

Department of Surgery University Hospital Ostrava 17 listopadu 1790 708 52 Ostrava Czech Republic

Department of Surgical Studies Faculty of Medicine University of Ostrava Syllabova 19 703 00 Ostrava Czech Republic

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Londono-Schimmer EE, Leaong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37(9):916–920 DOI

Gillern S, Bleier JI (2014) Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials. Clin Colon Rectal Surg 27:162–171 PubMed DOI PMC

Hansson BME, Morales-Conde S, Mussack T, Valdes J, Muysoms FE, Bleichrodt RP (2013) The laparoscopic modified Sugarbaker technique is safe and has a low recurrence rate: a multicenter cohort study. Surg Endosc 27:494–500 PubMed DOI

Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90(7):784–793 DOI

O’Neill CH, Borrazzo EC, Hyman NH (2015) Parastomal hernia repair. J Gastrointest Surg 19:766–769 PubMed DOI

Cheung MT, Chia NH, Chiu WY (2001) Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 44:266–271 DOI

Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M (2011) Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 148:e435–e441 DOI

Asif A, Ruiz M. Yetasook A, Denham W, Linn J, Carbray J, Ujiki MB (2012) Laparoscopic modified Sugerbaker technique results in superior recurrence rate. Surg Endosc 26:3430–3434 PubMed DOI

Kald A, Juul KN, Hjortsvang H, Sjodahl RI (2008) Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 43:627–633 PubMed DOI

Ihnát P, Guňková P, Peteja M, Vávra P, Pelikán A, Zonča P (2016) Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc 30(11):4809–4816 PubMed DOI

Funahashi K, Suzuki R, Nagashima Y, Matsuda S, Koike J, Shiokawa H, Ushigome M, Arai K, Kaneko T, Kurihara A, Kaneko H (2014) Risk factors for parastomal hernia in Japanese patients with permanent colostomy. Surg Today 44:1465–1469 DOI

Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, Breukink S (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200

Tan WJ, Chew MH, Dharmawan AR, Singh M, Acharyya S, Loi CT, Tanq CL (2016) Critical appraisal of laparoscopic vs open rectal cancer surgery. World J Gastrointest Surg 8(6):452 PubMed DOI PMC

Ng SS, Lee JF, Yiu RY, Li JC, Hon SS, Mak TW, Leung WW, Leunq KL (2014) Long-term oncologic outcomes of laparoscopic versus open surgery for rectal cancer: a pooled analysis of 3 randomized controlled trials. Ann Surg 259(1):139–147 PubMed DOI

Agha A, Benseler V, Hornung M, Gerken M, Iesalnieks I, Fürst A, Anthuber M, Jauch KW, Schlitt HJ (2014) Long-term oncologic outcome after laparoscopic surgery for rectal cancer. Surg Endosc 28(4):1119–1125 PubMed DOI

Ihnát P, Martínek L, Mitták M, Vávra P, Ihnát Rudinská L, Zonča P (2014) Quality of life after laparoscopic and open resection of colorectal cancer. Dig Surg 31(3):161–168 PubMed DOI

Randall J, Lord B, Fulham J, Soin B (2012) Parastomal hernias as the predominant stoma complication after laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 22(5):420–423 PubMed DOI

Carne PW, Frye JN, Robertson GM, Frizelle FA (2003) Parastomal hernia following minimally invasive stoma formation. ANZ J Surg 73(10):843–845 PubMed DOI

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616 PubMed DOI PMC

Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S (2009) The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 11:173–177 PubMed DOI

Hotouras A, Murphy J, Thaha M, Chan CL (2013) The persistent challenge of parastomal herniation: a review of the literature and future developments. Colorectal Dis 15(5):e202–e214 DOI

Malik T, Lee MJ, Harikrishnan AB (2018) The incidence of soma related morbidity—a systematic review of randomised controlled trials. Ann R Coll Surg Engl 100(7):501–508. https://doi.org/10.1308/rcsann.2018.0126 [Epub ahead of print] PubMed DOI

Petersson J, Koedam TW, Bonjer HJ, Andersson J, Angenete E, Bock D, Cuesta MA, Deijen CL, Furst A, Lacz AM, Rosenberg J, Haglind E, COlorectal cancer Laparoscopic or Open Resection (COLOR) II Study Group (2018) Bowel obstruction and ventral hernia after laparoscopic versus open surgery for rectal cancer in a randomized trial (COLOR II). Ann Surg. https://doi.org/10.1097/SLA.0000000000002790 [Epub ahead of print] DOI

Aguina CT, Iannuzzi JC, Probst CP, Kelly KN, Noyes K, Fleming FJ, Monson JRT (2014) Parastomal hernia: a growing problem with new solutions. Dig Surg 31:366–376 DOI

Ihnát P, Ihnát Rudinská L, Zonča P (2014) Radiofrequency energy in surgery: state of the art. Surg Today 44(6):985–991 PubMed DOI

Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255:685–695 PubMed DOI

Slater NJ, hansson BME, Buyne OR, Hendriks T, Bleichrodt RP (2011) Repair of parastomal hernias with biological grafts: a systematic review of the literature. J Gastrointest Surg 15:1252–1258 PubMed DOI PMC

Hansson BME (2013) Parastomal hernia: treatment and prevention 2013; where do we go from here? Colorectal Dis 15:1467–1470 PubMed DOI

Cingi A, Carik T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563 PubMed DOI

Janson AR, Janes A, Israelsson LA (2010) Laparoscopic stoma formation with a prophylactic prosthetic mesh. Hernia 14:495–498 PubMed DOI

Jones HG, Rees M, Aboumarzouk OM, Brown J, Cragg J, Billings P, Carter B, Chandran P (2018) Prosthetic mesh placement for the prevention of parastomal herniation. Cochrane Database Syst Rev 7:CD008905

Findlay JM, Wood CPJ, Cunninham C (2018) Prophylactic mesh reinforcement of stomas: a cost-effectiveness meta-analysis of randomised controlled trials. Tech Coloproctol. https://doi.org/10.1007/s10151-018-1774-5 [Epub ahead of print] PubMed DOI PMC

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