Interpretation of 2017 European Hernia Society Guidelines for The Prevention and Treatment of Parastomal Hernias / 中华胃肠外科杂志

ABSTRACT

European Hernia Society issued a guideline for the prevention and treatment of parastomal hernias in 2017, which is the first international guideline for the parastomal hernia. This guideline proposed 12 problems about incidence, diagnosis and treatment, and discussed these problems in depth. The main contents of this guideline are summarized as follows (1) End colostomy is associated with a higher incidence of parastomal hernia compared to other types of stomas. (2) Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. (3) The use of the European Hernia Society classification for uniform research reporting is recommended. (4) There is insufficient evidence on the policy in watchful waiting. (5) There is insufficient evidence on the route and location of stoma construction, and the size of the aperture. (6) The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present.(7) It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. (8) So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, most data in this guideline were retrospective without high level evidence. A lot of questions remain controversial and more high-level evidence are expected to solve these problems.