Elisa Mäkäräinen- Gastrointestinal Surgery Department, Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland
Introduction: Parastomal hernia (PSH) is a common long-term complication following stoma creation. The incidence of PSH exceeds 50% in long-term follow-up of end colostomy patients, while it remains lower in ileostomies and ileal conduit urinary diversions. PSH prevention strategies are of interest due to the poor outcomes and high recurrence rates associated with PSH repair.
Overview of Techniques to Prevent PSH: Various technical approaches have been explored to reduce the risk of PSH. However, none have shown consistent benefit toward reducing PSH rate without the use of prophylactic mesh. The keyhole mesh technique was the first to demonstrate a significant reduction in PSH rates in early trials, but larger randomized controlled trials (RCTs) have later questioned its efficacy. The modified keyhole technique, using a funnel-shaped mesh, has shown promising results in recent small studies, with lower PSH incidence and potentially reduced stomal prolapse rate. Other methods such as the Sugarbaker technique and use of biological meshes in PSH prevention have been evaluated as well, with mixed results. While most research focuses on end colostomy, there is limited data on PSH prevention in ileostomies and ileal conduits.
Conclusion: Despite early enthusiasm, the keyhole technique has not proven to be effective in preventing PSH. The modified funnel-shaped mesh appears to be a promising development, though long-term outcomes are lacking. Preventive mesh placement is still supported by international guidelines; however, these recommendations are not widely followed in colorectal surgery departments. Thus, further research is essential to guide future recommendations for PSH prevention.
Introduction
Parastomal hernia (PSH) was first recognized as a complication of end colostomy in the 1990s [1]. PSH incidence is likely higher following end colostomy formation compared to ileostomy or ileal conduit urinary diversion [2]. In long-term follow-up studies, PSH rate has been shown to be over 50% for end colostomy patients [3, 4], while the incidence ranges from 7% to 36% for ileostomies [2, 5–7], and 10%–32% following ileal conduit urinary diversion [8–13].
PSH prevention is a reasonable goal due to high PSH incidence, especially after end colostomy without mesh, and the poor outcomes of PSH repair associated with high recurrence and complication rates [14]. PSH repair at the ileal conduit is seldom reported [15, 16]. Available data from small patient series indicate high morbidity and recurrence rates in line with findings from end colostomy PSH repairs [14–17].
PSH Prevention Strategies
Initial prevention strategies focused on surgical techniques and the significance of right stoma placement for lowering PSH incidence [18, 19]. Various technical principles have been proposed to decrease the PSH rate. For example, the size of the fascial opening appears relevant. Therefore, excessively large openings should be avoided [4, 20]. Neither the transrectus nor pararectus positions have demonstrated superiority in PSH prevention [21–23]. Although extraperitoneal stoma creation may reduce the risk of parastomal hernia (PSH), robust evidence is lacking, as current data are based mainly on retrospective case series reporting relatively low PSH rates [24–27]. The opening technique (cruciate vs. circular) of the fascial orifice does not seem to have any impact on PSH risk [28]. In conclusion, PSH cannot be effectively prevented without a mesh.
Keyhole Technique
The first randomized controlled trial (RCT) on PSH prevention used the keyhole mesh technique in the retrorectus space during open surgery [29]. Initial small-scale studies showed a significant reduction in PSH rates at 12 months’ follow-up [29, 30]. This method was widely adopted since, including in minimally invasive approaches. The keyhole technique has also been applied intraperitoneally with positive results during short-term follow-up [31]. However, larger recent RCTs have failed to confirm benefits of both retrorectus mesh placement [28, 32–34] and intraperitoneal keyhole technique [35], showing comparable PSH rates between mesh and non-mesh groups by both clinical and radiologic evaluation.
Modified Keyhole Technique
To address shortcomings of the retrorectus keyhole technique in PSH prevention and repair, a funnel-shaped mesh was developed. Since the first publication of funnel-shaped mesh as PSH prevention in 2008 [36], over a dozen studies have supported its potential benefits without increased complications. Both case series [37, 38] and comparative observational studies [39–44] have shown significant reduction in PSH rates with mesh. Diagnostic methods varied between clinical and computer tomography (CT) -based evaluations. As a complication, stomal retraction was noted in 16.1% (5/31) of patients with funnel-shaped mesh [38]. One RCT of the funnel-shaped mesh has been published to date, reporting PSH rates of 2% in the mesh group vs. 43% in non-mesh group at 12-month clinical follow-up, and 10% vs. 37% by CT scan, respectively [45]. There has also been a trend toward reduced stomal prolapse in the mesh group [43, 45], though statistical significance has not been demonstrated.
Other Techniques and Meshes
A single RCT has reported on the modified Sugarbaker technique, showing 22% PSH incidence in the mesh group compared to 44% in controls at 12 months’ follow-up [46]. A prospective case series using the same method reported a PSH rate of 7% [47]. Biological meshes are rarely used in PSH prevention [48, 49].
Systematic Reviews and Meta-Analyses
Earlier systematic reviews and meta-analyses consistently supported prophylactic mesh use to prevent PSH [50–62] (Table 1). However, as recent RCTs have not confirmed the advantage of retrorectus keyhole mesh [28, 32–34], some reviews now advise against routine use of prophylactic mesh [63, 67]. When only studies using funnel shaped mesh were included, though, a significant reduction in the PSH rate was observed [68]. The European Hernia Society (EHS) continues to conditionally recommend use the prophylactic mesh with end colostomies [69]. However, if the patient is at high risk of developing a PSH, the recommendation is strong [69].
Table 1. Results of systematic reviews of parastomal hernia prevention with a mesh.
Ileostomy PSH Prevention
PSH prevention in ileostomies is less frequently studied, partly due to lower incidence [2, 5–7] and possibly due to frequent association of ileostomies with inflammatory bowel disease, which may have led to reluctance to use mesh. In a small cohort publication, retrorectus keyhole mesh failed to prevent PSH [70], as did biological mesh [48] in ileostomies.
Ileal Conduit PSH Prevention
Ileal conduit PSH prevention and repair remains poorly studied topics. The PSH incidence is estimated at 10%–32% [8–13] but can be as high as 68% by CT scan [7]. Most cases are asymptomatic and do not require surgical repair. Thus far, keyhole mesh techniques have been trialed in ileal conduit procedures for PSH prevention. Liedberg et al. [71] reported a significant reduction in PSH using retrorectus keyhole mesh. However, Donahue et al. found an 18% PSH rate on CT after a median follow-up of 297 days, despite the retrorectus keyhole mesh [72]. A recent RCT using intra-abdominal biological keyhole mesh found no benefit in PSH prevention [73].
Discussion
The era of PSH prevention began two decades ago with promising results using the keyhole technique. However, its efficacy in end colostomy PSH prevention has since been questioned in large RCTs with no difference in PSH rate between the mesh and non-mesh groups. The modified keyhole technique appears to offer a potential alternative with encouraging results published so far. Until 2016, only funnel-shaped mesh with a 2-cm-long funnel was available. Studies have widely used this version of mesh [41–43]. Today, the mesh with 4-cm long funnel is commonly used to provide better coverage around the bowel, therefore possibly decreasing the likelihood of PSH [45].
As most studies focus on end colostomies, EHS and The Association of Coloproctology of Great Britain and Ireland (ACPGBI) recommend prophylactic mesh in permanent colostoma formation only [4, 69, 74]. Recommendations on ileostoma or ileal conduit parastomal hernia prevention cannot be given, despite the poor results of repair and relatively high PSH rate [2, 5–7, 15]. Despite the recommendations, mesh use remains limited [75, 76]. Additionally, the intra-abdominal location of modified keyhole meshes and lack of long-term follow-up results may hinder wider adoption, although no significant mesh-related complications have been reported due to the location of the mesh.
Ileal conduit PSH prevention may follow a similar progression to end colostoma PSH prevention. By far, retrorectus keyhole mesh has shown benefits in ileal conduit PSH rate. However, further research is needed to trial especially the modified keyhole technique in both ileal conduits and end ileostomies as well. Additionally, in modified keyhole technique studies the patient populations have had relatively low mean BMIs and further research should focus on mesh usability in higher BMI patient populations.
Conclusion
Parastomal hernia is still a common and challenging complication after stoma creation even two decades after the introduction of PSH prevention techniques. While the traditional keyhole mesh technique does not prevent PSHs, the modified funnel-shaped mesh offers a potential option. Existing data, although limited, suggest reduction in PSH incidence without increased complications. However, further high-quality, large-scale research, particularly in patients with higher BMI and in ileal conduit or ileostomy populations with sufficient follow-up time, is needed to guide future practice. Despite current guidelines and recommendations, prophylactic mesh remains underutilized.
Author Contributions
The author confirms being the sole contributor of this work and has approved it for publication.
Funding
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Acknowledgments
I would like to thank Professor Tero Rautio for his comments during the preparation of the manuscript.
References
1. Londono-Schimmer, E, Leong, A, and Phillips, R. Life Table Analysis of Stomal Complications Following Colostomy. Dis Colon Rectum (1994) 37:916–20. doi:10.1007/BF02052598
2. Ripoche, J, Basurko, C, Fabbro-Perray, P, and Prudhomme, M. Parastomal Hernia. A Study of the French Federation of Ostomy Patients. J Visc Surg (2011) 148:e435–41. doi:10.1016/j.jviscsurg.2011.10.006
3. Jänes, A, Cengiz, Y, and Israelsson, L. Preventing Parastomal Hernia with a Prosthetic Mesh: A 5-Year Follow-Up of a Randomized Study. World J Surg (2009) 33:118–23. doi:10.1007/s00268-008-9785-4
4. Antoniou, S, Agresta, F, Garcia Alamino, J, Berger, D, Berrevoet, F, Brandsma, H, et al. European Hernia Society Guidelines on Prevention and Treatment of Parastomal Hernias. Hernia (2018) 22:183–98. doi:10.1007/s10029-017-1697-5
5. Etherington, R, Williams, J, Hayward, M, and Hughes, L. Demonstration of Para-Ileostomy Herniation Using Computed Tomography. Clin Radiol (1990) 41:333–6. doi:10.1016/s0009-9260(05)81696-4
6. Carne, P, Robertson, G, and Frizelle, F. Parastomal Hernia. Br J Surg (2003) 90:784–93. doi:10.1002/bjs.4220
7. Blanc, P, Fournel, I, Bel, N, Delchet, O, Belloni, E, Renard, Y, et al. Parastomal Hernia After Ileal Conduit: Incidence, Natural History and Risk Factors. World J Surg (2024) 48:2413–20. doi:10.1002/wjs.12317
8. Nomura, T, Mimata, H, Yamasaki, M, Sumino, Y, Moriyama, H, Touhara, K, et al. Repair of Ileal Conduit Parastomal Hernia by Translocation of the Stoma. Int J Urol (2003) 10:680–2. doi:10.1046/j.1442-2042.2003.00725.x
9. Ho, K, and Fawcett, D. Parastomal Hernia Repair Using the Lateral Approach. BJU Int (2004) 94:598–602. doi:10.1111/j.1464-410X.2004.05008.x
10. Donahue, T, Bochner, B, Sfakianos, J, Kent, M, Bernstein, M, Hilton, W, et al. Risk Factors for the Development of Parastomal Hernia After Radical Cystectomy. J Urol (2014) 191:1708–13. doi:10.1016/j.juro.2013.12.041
11. Narang, S, Alam, N, Campain, N, Pathak, S, McGrath, J, Daniels, I, et al. Parastomal Hernia Following Cystectomy and Ileal Conduit Urinary Diversion: A Systematic Review. Hernia (2017) 21:163–75. doi:10.1007/s10029-016-1561-z
12. Rodriguez Faba, O, Rosales, A, Breda, A, Palou, J, Gaya, J, Esquena, S, et al. Simplified Technique for Parastomal Hernia Repair After Radical Cystectomy and Ileal Conduit Creation. Urology (2011) 77:1491–4. doi:10.1016/j.urology.2010.11.047
13. Hussein, A, Ahmed, Y, May, P, Ali, T, Ahmad, B, Raheem, S, et al. Natural History and Predictors of Parastomal Hernia After Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion. J Urol (2018) 199:766–73. doi:10.1016/j.juro.2017.08.112
14. Mäkäräinen-Uhlbäck, E, Vironen, J, Falenius, V, Nordström, P, Välikoski, A, Kössi, J, et al. Parastomal Hernia: A Retrospective Nationwide Cohort Study Comparing Different Techniques with Long-Term Follow-Up. World J Surg (2021) 45:1742–9. doi:10.1007/s00268-021-05990-z
15. Mäkäräinen-Uhlbäck, E, Vironen, J, Vaarala, M, Nordström, P, Välikoski, A, Kössi, J, et al. Keyhole Versus Sugarbaker Techniques in Parastomal Hernia Repair Following Ileal Conduit Urinary Diversion: A Retrospective Nationwide Cohort Study. BMC Surg (2021) 21:231. doi:10.1186/s12893-021-01228-w
16. Haque, TF, Ghoreifi, A, Sheybaee Moghaddam, F, Kaneko, M, Ginsberg, D, Sotelo, R, et al. Perioperative and Extended Outcomes of Patients Undergoing Parastomal Hernia Repair Following Cystectomy and Ileal Conduit. World J Urol (2024) 42:482. doi:10.1007/s00345-024-05123-w
17. Bel, N, Blanc, PY, Moszkowicz, D, Kim, B, Deballon, PO, Berrada, D, et al. Surgical Management of Parastomal Hernia Following Radical Cystectomy and Ileal Conduit: A French Multi-Institutional Experience. Langenbecks Arch Surg (2023) 408:344. doi:10.1007/s00423-023-03062-5
18. Sjödahl, R, Anderberg, B, and Bolin, T. Parastomal Hernia in Relation to Site of the Abdominal Stoma. Br J Surg (1988) 75:339–41. doi:10.1002/bjs.1800750414
19. Ortiz, H, Sara, M, Armendariz, P, de Miguel, M, Marti, J, and Chocarro, C. Does the Frequency of Paracolostomy Hernias Depend on the Position of the Colostomy in the Abdominal Wall? Int J Colorectal Dis (1994) 9:65–7. doi:10.1007/bf00699414
20. Hotouras, A, Murphy, J, Power, N, Williams, N, and Chan, C. Radiological Incidence of Parastomal Herniation in Cancer Patients with Permanent Colostomy: What Is the Ideal Size of the Surgical Aperture? Int J Surg (2013) 11:425–7. doi:10.1016/j.ijsu.2013.03.010
21. Hardt, J, Seyfried, S, Weiß, C, Post, S, Kienle, P, and Herrle, F. A Pilot Single-Centre Randomized Trial Assessing the Safety and Efficacy of Lateral Pararectus Abdominis Compared with Transrectus Abdominis Muscle Stoma Placement in Patients with Temporary Loop Ileostomies: The PATRASTOM Trial. Colorectal Dis (2016) 18:81–90. doi:10.1111/codi.13251
22. Hardt, J, Meerpohl, J, Metzendorf, M, Kienle, P, Post, S, and Herrle, F. Lateral Pararectal Versus Transrectal Stoma Placement for Prevention of Parastomal Herniation. Cochrane Database Syst Rev (2019) 4:CD009487. doi:10.1002/14651858.CD009487.pub3
23. Ho, K, Economou, T, Smart, N, and Daniels, I. Radiological Progression of End Colostomy Trephine Diameter and Area. BJS open (2018) 3:112–8. doi:10.1002/bjs5.50109
24. Hino, H, Yamaguchi, T, Kinugasa, Y, Shiomi, A, Kagawa, H, Yamakawa, Y, et al. Relationship Between Stoma Creation Route for End Colostomy and Parastomal Hernia Development After Laparoscopic Surgery. Surg Endosc (2017) 31:1966–73. doi:10.1007/s00464-016-5198-x
25. Kroese, L, de Smet, G, Jeekel, J, Kleinrensink, G, and Lange, J. Systematic Review and Meta-Analysis of Extraperitoneal Versus Transperitoneal Colostomy for Preventing Parastomal Hernia. Dis Col Rec (2016) 59:688–95. doi:10.1097/DCR.0000000000000605
26. Isah, A, Wang, X, Shaibu, Z, Yuan, X, and Dang, SC. Systematic Review and Meta-Analysis Comparing Extraperitoneal and Transperitoneal Routes of Colostomy-Related Complications. World J Gastrointest Surg (2025) 17:98947. doi:10.4240/wjgs.v17.i3.98947
27. Luo, J, Singh, D, Zhang, F, Yang, X, Zha, X, Jiang, H, et al. Comparison of the Extraperitoneal and Transperitoneal Routes for Permanent Colostomy: A Meta-Analysis with Rcts and Systematic Review. World J Surg Oncol (2022) 20:82. doi:10.1186/s12957-022-02547-9
28. Correa, MA, Bock, D, Erestam, S, Engström, A, Kälebo, P, Nielsen, Y, et al. Methods of Colostomy Construction: No Effect on Parastomal Hernia Rate: Results from Stoma-const-A Randomized Controlled Trial. Ann Surg (2021) 273:640–7. doi:10.1097/SLA.0000000000003843
29. Jänes, A, Cengiz, Y, and Israelsson, L. Preventing Parastomal Hernia with a Prosthetic Mesh. Arch Surg (2004) 139:1356–8. doi:10.1001/archsurg.139.12.1356
30. Lambrecht, J, Larsen, S, Reiertsen, O, Vaktskjold, A, Julsrud, L, and Flatmark, K. Prophylactic Mesh at End-Colostomy Construction Reduces Parastomal Hernia Rate: A Randomized Trial. Colorectal Dis (2015) 17:191–7. doi:10.1111/codi.13065
31. Vierimaa, M, Klintrup, K, Biancari, F, Victorzon, M, Carpelan-Holmström, M, Kössi, J, et al. Prospective, Randomized Study on the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia of Permanent Colostomy. Dis Colon Rectum (2015) 58:943–9. doi:10.1097/dcr.0000000000000443
32. Odensten, C, Strigård, K, Rutegård, J, Dahlberg, M, Ståhle, U, Gunnarsson, U, et al. Use of Prophylactic Mesh when Creating a Colostomy Does Not Prevent Parastomal Hernia: A Randomized Controlled Trial-STOMAMESH. Ann Surg (2019) 269:427–31. doi:10.1097/sla.0000000000002542
33. Prudhomme, M, Rullier, E, Lakkis, Z, Cotte, E, Panis, Y, Meunier, B, et al. End Colostomy with or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7): A Prospective, Randomized, Double Blinded, Multicentre Trial. Ann Surg (2021) 274:928–34. doi:10.1097/SLA.0000000000004371
34. Ringblom, C, Odensten, C, Strigård, K, Gunnarsson, U, and Näsvall, P. No Reduction in Parastomal Hernia Rate 3 Years After Stoma Construction with Prophylactic Mesh: Three-Year Follow-up Results from STOMAMESH-A Multicenter Double-Blind Randomized Controlled Trial. Ann Surg (2023) 277:38–42. doi:10.1097/SLA.0000000000005537
35. Mäkäräinen-Uhlbäck, E, Klintrup, K, Vierimaa, M, Carpelan-Holmström, M, Kössi, J, Kairaluoma, M, et al. Prospective, Randomized Study on the Use of Prosthetic Mesh to Prevent a Parastomal Hernia in a Permanent Colostomy: Results of a Long-Term Follow-Up. Dis Colon Rectum (2020) 63:678–84. doi:10.1097/DCR.0000000000001599
36. Berger, D. Prevention of Parastomal Hernias by Prophylactic Use of a Specially Designed Intraperitoneal Onlay Mesh (Dynamesh IPST). Hernia (2008) 12:243–6. doi:10.1007/s10029-007-0318-0
37. Köhler, G, Hofmann, A, Lechner, M, Mayer, F, Wundsam, H, Emmanuel, K, et al. Prevention of Parastomal Hernias with 3D Funnel Meshes in Intraperitoneal Onlay Position by Placement During Initial Stoma Formation. Hernia (2016) 20:151–9. doi:10.1007/s10029-015-1380-7
38. Conde-Muíño, R, Díez, JL, Martínez, A, Huertas, F, Segura, I, and Palma, P. Preventing Parastomal Hernias with Systematic Intraperitoneal Specifically Designed Mesh. BMC Surg (2017) 17:41. doi:10.1186/s12893-017-0237-7
39. Zoltan, J, and Nagy, A. Results of 3-Dimensional Mesh Implantations at the Time of Miles Operation to Prevent Parastomal Hernia. Eur Surg (2014) 46:25–31. doi:10.1007/s10353-013-0245-5
40. Zoltan, J, Mohos, E, Réti, G, Kovács, T, Mohay, J, Berki, C, et al. Prevention and Management of Parastomal Hernias: Our Experience with Three-Dimensional Meshes. Magy Seb (2016) 69:150–8. doi:10.1556/1046.69.2016.4.2
41. López-Borao, J, Madrazo-González, Z, Kreisler, E, and Biondo, S. Prevention of Parastomal Hernia After Abdominoperineal Excision with a Prophylactic Three-Dimensional Funnel Mesh. Colorectal Dis (2019) 21:1326–34. doi:10.1111/codi.14738
42. Ammann, Y, Widmann, B, Sparn, M, Warschkow, R, Weitzendorfer, M, and Brunner, W. Prophylactic Funnel Mesh to Prevent Parastomal Hernia in Permanent End Colostomy: A Retrospective Cohort Study. Colorectal Dis (2021) 23:2627–36. doi:10.1111/codi.15817
43. Bertoglio, CL, Maspero, M, Morini, L, Zironda, A, Alampi, BD, Mazzola, M, et al. Permanent End-Colostomy Parastomal Hernia Prevention Using a Novel Three-Dimensional Mesh. Hernia (2021) 25:655–63. doi:10.1007/s10029-020-02326-z
44. Badia-Closa, J, Comas-Isus, J, Centeno-Alvarez, A, Arrayás-Valverde, A, Subirana-Magdaleno, H, Sobrerroca-Porras, L, et al. Parastomal Hernia Prevention with an Intraperitoneal Prophylactic 3D-Funnel Mesh: Review of the Technique and Middle-Term Results. Hernia (2024) 28:1129–35. doi:10.1007/s10029-024-02989-y
45. Mäkäräinen, E, Wiik, H, Nikberg, M, Kössi, J, Carpelan-Holmström, M, Pinta, T, et al. Parastomal Hernia Prevention Using Funnel-Shaped Intra-Abdominal Mesh Compared to No Mesh: The Chimney Randomized Clinical Trial. JAMA Surg (2024) 159:1244–50. doi:10.1001/jamasurg.2024.3260
46. López-Cano, M, Serra-Aracil, X, Mora, L, Sánchez-García, J, Jiménez-Gómez, L, Martí, M, et al. Preventing Parastomal Hernia Using a Modified Sugarbaker Technique with Composite Mesh During Laparoscopic Abdominoperineal Resection: A Randomized Controlled Trial. Ann Surg (2016) 264:923–8. doi:10.1097/sla.0000000000001684
47. Hauters, P, Cardin, JL, Lepere, M, Valverde, A, Cossa, JP, Auvray, S, et al. Long-Term Assessment of Parastomal Hernia Prevention by Intra-Peritoneal Mesh Reinforcement According to the Modified Sugarbaker Technique. Surg Endosc (2016) 30:5372–9. doi:10.1007/s00464-016-4891-0
48. Fleshman, J, Beck, D, Hyman, N, Wexner, S, Bauer, J, George, V, et al. A Prospective, Multicenter, Randomized, Controlled Study of Non-Cross-Linked Porcine Acellular Dermal Matrix Fascial Sublay for Parastomal Reinforcement in Patients Undergoing Surgery for Permanent Abdominal Wall Ostomies. Dis Colon Rectum (2014) 57:623–31. doi:10.1097/dcr.0000000000000106
49. Fortelny, R, Hofmann, A, May, C, and Köckerling, F, BioMesh Study Group. Prevention of a Parastomal Hernia by Biological Mesh Reinforcement. Front Surg (2015) 2:53. doi:10.3389/fsurg.2015.00053
50. Tam, K, Wei, P, Kuo, L, and Wu, C. Systematic Review of the Use of a Mesh to Prevent Parastomal Hernia. World J Surg (2010) 34:2723–9. doi:10.1007/s00268-010-0739-2
51. Wijeyekoon, S, Gurusamy, K, El-Gendy, K, and Chan, C. Prevention of Parastomal Herniation with Biologic/Composite Prosthetic Mesh: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Coll Surg (2010) 211:637–45. doi:10.1016/j.jamcollsurg.2010.06.111
52. Shabbir, J, Chaudhary, B, and Dawson, R. A Systematic Review on the Use of Prophylactic Mesh During Primary Stoma Formation to Prevent Parastomal Hernia Formation. Colorectal Dis (2012) 14:931–6. doi:10.1111/j.1463-1318.2011.02835.x
53. Sajid, M, Kalra, L, Hutson, K, and Sains, P. Parastomal Hernia as a Consequence of Colorectal Cancer Resections Can Prophylactically Be Controlled by Mesh Insertion at the Time of Primary Surgery: A Literature Based Systematic Review of Published Trials. Minerva chirurgica (2012) 67:289–96.
54. Wang, S, Wang, W, Zhu, B, Song, G, and Jiang, C. Efficacy of Prophylactic Mesh in End-Colostomy Construction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. World J Surg (2016) 40:2528–36. doi:10.1007/s00268-016-3576-0
55. Zhu, J, Pu, Y, Yang, X, Zhang, D, Zhao, K, Peng, W, et al. Prophylactic Mesh Application During Colostomy to Prevent Parastomal Hernia: A Meta-Analysis. Gastroenterol Res Pract (2016) 2016:1694265. doi:10.1155/2016/1694265
56. Chapman, S, Wood, B, Drake, T, Young, N, and Jayne, D. Systematic Review and Meta-Analysis of Prophylactic Mesh During Primary Stoma Formation to Prevent Parastomal Hernia. Dis Colon Rectum (2017) 60:107–15. doi:10.1097/DCR.0000000000000670
57. Cornille, J, Pathak, S, Daniels, I, and Smart, N. Prophylactic Mesh Use During Primary Stoma Formation to Prevent Parastomal Hernia. Ann R Coll Surgeons (2017) 99:2–11. doi:10.1308/rcsann.2016.0186
58. Cross, A, Buchwald, P, Frizelle, F, and Eglinton, T. Meta-Analysis of Prophylactic Mesh to Prevent Parastomal Hernia. Br J Surg (2017) 2017104:179–86. doi:10.1002/bjs.10402
59. López-Cano, M, Brandsma, H, Bury, K, Hansson, B, Kyle-Leinhase, I, Alamino, J, et al. Prophylactic Mesh to Prevent Parastomal Hernia After End Colostomy: A Meta-Analysis and Trial Sequential Analysis. Hernia (2017) 21:177–89. doi:10.1007/s10029-016-1563-x
60. Patel, S, Zhang, L, Chadi, S, and Wexner, S. Prophylactic Mesh to Prevent Parastomal Hernia: A Meta-Analysis of Randomized Controlled Studies. Tech Coloproctol (2017) 21:5–13. doi:10.1007/s10151-016-1559-7
61. Pianka, F, Probst, P, Keller, A, Saure, D, Grummich, K, Büchler, M, et al. Prophylactic Mesh Placement for the Prevention of Parastomal Hernias: The PRESTO Systematic Review and Meta-Analysis. PloS one (2017) 12:e0171548. doi:10.1371/journal.pone.0171548
62. Jones, H, Rees, M, Aboumarzouk, O, Brown, J, Cragg, J, Billings, P, et al. Prosthetic Mesh Placement for the Prevention of Parastomal Herniation. Cochrane Database Syst Rev (2018) 7:Cd008905. doi:10.1002/14651858.CD008905.pub3
63. Prudhomme, M, Fabbro-Peray, P, Rullier, E, Occean, B, and Bertrand, M. Meta-Analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia. Ann Surg (2021) 274:20–8. doi:10.1097/SLA.0000000000004704
64. Sahebally, S, Lim, T, Azmir, A, Lu, C, Doudle, M, Naik, A, et al. Prophylactic Mesh Placement at Index Permanent End Colostomy Creation to Prevent Parastomal Hernia-An Updated Meta-Analysis. Int J Colorectal Dis (2021) 36:2007–16. doi:10.1007/s00384-021-03924-8
65. Dewulf, M, Hildebrand, ND, Bouwense, SAW, Bouvy, ND, and Muysoms, F. Parastomal Hernias After Cystectomy and Ileal Conduit Urinary Diversion: Surgical Treatment and the Use of Prophylactic Mesh: A Systematic Review. BMC Surg (2022) 22:118. doi:10.1186/s12893-022-01509-y
66. Hinojosa-Gonzalez, DE, Saffati, G, Kronstedt, S, La, T, Chaput, M, Desai, S, et al. Use of Prophylactic Mesh to Prevent Parastomal Hernia Formation: A Systematic Review, Meta-Analysis and Network Meta-Analysis. Hernia (2024) 29:22. doi:10.1007/s10029-024-03219-1
67. Verdaguer-Tremolosa, M, Garcia-Alamino, JM, Rodrigues-Gonçalves, V, Martínez-López, MP, and López-Cano, M. Prophylactic Mesh Does Not Prevent Parastomal Hernia in Long-Term: Meta-Analysis and Trial Sequential Analysis. Surgery (2024) 175:441–50. doi:10.1016/j.surg.2023.09.038
68. Pompeu, B, Guedes, L, Bossi, B, Delgado, L, Frizzo, C, Gauch, I, et al. Prophylactic Funnel Mesh for Preventing Parastomal Hernia in Patients with Permanent End Stoma: A Systematic Review and Meta-Analysis. Hernia (2025) 29:84. doi:10.1007/s10029-025-03262-6
69. Tzanis, AA, Stabilini, C, Muysoms, FE, Rossi, L, Koutsiouroumpa, O, Mavridis, D, et al. Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention-A EHS, ESCP and EAES Collaborative Project. J Abdom Wall Surg (2023) 2:11550. doi:10.3389/jaws.2023.11550
70. Frigault, J, Lemieux, S, Breton, D, Bouchard, P, Bouchard, A, Grégoire, RC, et al. Prophylactic Retromuscular Mesh Placement for Parastomal Hernia Prevention: A Retrospective Cohort Study of Permanent Colostomies and Ileostomies. Hernia (2022) 26:495–506. doi:10.1007/s10029-021-02440-6
71. Liedberg, F, Kollberg, P, Allerbo, M, Baseckas, G, Brändstedt, J, Gudjonsson, S, et al. Preventing Parastomal Hernia After Ileal Conduit by the Use of a Prophylactic Mesh: A Randomised Study. Eur Urol (2020) 78:757–63. doi:10.1016/j.eururo.2020.07.033
72. Donahue, TF, Cha, EK, and Bochner, BH. Rationale and Early Experience with Prophylactic Placement of Mesh to Prevent Parastomal Hernia Formation After Ileal Conduit Urinary Diversion and Cystectomy for Bladder Cancer. Curr Urol Rep (2016) 17:9. doi:10.1007/s11934-015-0565-z
73. Djaladat, H, Ghoreifi, A, Tejura, T, Miranda, G, Cai, J, Sheybaee Moghaddam, F, et al. Prophylactic Use of Biologic Mesh in Ileal Conduit (PUBMIC): A Randomized Clinical Trial. J Urol (2024) 211:743–53. doi:10.1097/JU.0000000000003902
74. ACPGBI Parastomal Hernia Group. Prevention and Treatment of Parastomal Hernia: A Position Statement on Behalf of the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis (2018) 20(Suppl. 2):5–19. doi:10.1111/codi.14249
75. Holland, J, Chesney, T, Dossa, F, Acuna, S, Fleshner, K, and Baxter, N. Do North American Colorectal Surgeons Use Mesh to Prevent Parastomal Hernia? A Survey of Current Attitudes and Practice. Can J Surg (2019) 62:426–35. doi:10.1503/cjs.019018
Keywords: parastomal hernia, prevention, keyhole technique, modified keyhole technique, Sugarbaker technique
Citation: Mäkäräinen E (2025) Prophylactic Mesh in Parastomal Hernia Prevention: Current Evidence. J. Abdom. Wall Surg. 4:15011. doi: 10.3389/jaws.2025.15011
Received: 01 June 2025; Accepted: 21 July 2025;
Published: 30 July 2025.
Copyright © 2025 Mäkäräinen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Elisa Mäkäräinen, ZWxpc2EubWFrYXJhaW5lbkBwb2hkZS5maQ==