The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.

Disclosures: Robert R Cima, MD, MA, FACS, FASCRS Nothing to disclose. Richard Turnage, MD Nothing to disclose. Kathryn A Collins, MD, PhD, FACS Nothing to disclose.

Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.

Conflict of interest policy

All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Mar 2014. | This topic last updated: Jan 13, 2014.

INTRODUCTION — A parastomal hernia (PSH) is a type of incisional hernia that occurs at the site of the stoma or immediately adjacent to the stoma (image 1). It forms when the abdominal wall defect, the trephine, is continually stretched by the tangential forces applied along the circumference of the abdominal wall opening [1].

The construction of an ostomy and the management of patients with an ileostomy or colostomy are reviewed separately. (See "Surgical principles of ostomy construction" and "Management of patients with a colostomy or ileostomy".)

INCIDENCE — A parastomal hernia (PSH) is the most frequent complication following the construction of a colostomy or an ileostomy. It has even been suggested that a certain degree of PSH is almost inevitable [2].

The reported incidence varies widely and is related to a number of factors including: the lack of a standard definition, type of ostomy constructed, and variability in the duration of follow-up after ostomy construction [3-13]. A minor degree of parastomal weakness is present in many patients and does not represent a true hernia [14].

A review found that PSH occurs in 1.8 to 28.3 percent of patients with end-ileostomy, 0 to 6.2 percent with loop ileostomy, 4.0 to 48.1 percent with end-colostomy, and 0 to 30.8 percent with loop colostomies [15]. The lower rate for loop ostomy is related to the temporary nature of most of these stomas and the short duration of follow-up. Most parastomal hernias occur within the first two years of construction, and studies with longer follow-up report higher PSH rates [16].  

CLASSIFICATION — The hernia sac may contain bowel and/or omentum. Parastomal hernia (PSH) is classified clinically into four subtypes (figure 1) [17]:

Subcutaneous (most common type) - The herniation extrudes from the abdomen alongside the bowel for the stoma and bulges into the subcutaneous fat alongside the stoma.

Interstitial - The herniation extrudes alongside the bowel for the stoma, then burrows into one of the intermuscular planes.

Perstomal - The stomal bowel is prolapsed and loops of bowel and/or omentum enter the hernia space produced between the layers of the prolapsed bowel.

Intrastomal - The herniation extrudes from the abdomen alongside the bowel for the stoma and enters the plane between the emerging and the everted part of the bowel. It usually occurs in the spout type of stoma such as an ileostomy.

A radiologic classification scheme using findings from cross sectional imaging has also been developed [18]. This scheme distinguishes between possible contents of the hernia sac, including omentum, the loop of bowel forming the ostomy, and other loops of bowel not forming the ostomy.

While these classification schemes may be useful in research and for academic discussions, in practice there is little need for such a system since management is based on the symptoms induced by the hernia, rather than differences in the hernia composition, which may be difficult to appreciate on physical examination.

RISK FACTORS — Patient characteristics that have been associated with an increased risk of parastomal hernia (PSH) formation include obesity, weight gain after ostomy construction, poor nutritional status, immunosuppressive drugs (eg, corticosteroids), emergency construction of a stoma, chronic or recurrent increases in abdominal pressure (chronic coughing), infection, and underlying disease such as malignancy or inflammatory bowel disease [19-23]. Of these, the association with obesity, defined as waist circumference >100 cm or body mass index >30 kg/m2, is best supported by clinical evidence [7,23].

Technical factors that might influence the risk of PSH formation include stoma placement, surgical technique for ostomy construction, and abdominal wall strength [24,25]. The size of the trephine may be particularly important. An analysis of the forces acting upon the trephine that cause dilatation, thus a hernia, revealed that the larger the trephine radius, the stronger the tangential force pulling the trephine apart [1]. This physical analysis supports the clinical findings that PSH is less common following an ileostomy than a colostomy or end stoma as compared with a loop stoma [14]. One study evaluated patients with permanent colostomies and found that no patient with an abdominal wall opening ≤25 mm developed a PSH at a median follow-up of 26 months, further supporting the concept that a smaller trephine is less likely to lead to PSH [16].

There is also increasing evidence that herniation in general is the result of an intrinsic defect in collagen metabolism and wound repair [26-28]. Hence, prosthetic mesh has been introduced to minimize tension on fascia in hernia repairs.

PREVENTION — The development of parastomal hernia (PSH) after construction on an ostomy has, in different studies and different techniques, occurred in 0 to 48 percent of patients (see 'Incidence' above). In an attempt to reduce the rate of PSH, the current focus is on modifying risk factors for PSH formation prior to surgery and on better primary stomal construction techniques to strengthen the abdominal wall [29-37].

Small single institution experiences from the late 1990s suggested that placement of mesh at the time of stoma construction was safe and effective for preventing PSH. The first data on prevention of PSH came from a randomized trial in which 54 patients who required a colostomy following an abdominal perineal resection were randomly assigned to ostomy construction with or without sublay mesh (figure 2) [29]. There were significantly fewer parastomal hernias in the mesh group (15 versus 41 percent) with no difference in complication rates. There were no episodes of mesh intolerance or the need to remove the mesh during the two year follow-up period. Subsequently, a number of other studies have similarly concluded that prophylactic mesh placement significantly reduces the incidence of PSH with few complications [38-40]. Biologic mesh, rather than synthetic mesh, has also been used in fewer patients with limited follow-up, but with a reduced incidence in PSH formation [41]. A cost analysis predicted that the use of prophylactic mesh to prevent PSH was overall less expensive and more effective compared with no mesh [42].

CLINICAL MANIFESTATIONS — Most patients with a parastomal hernia (PSH) are asymptomatic and do not require surgical repair. They typically present with a bulge at the site of or adjacent to the intestinal stoma, with or without pain (picture 1). Symptoms range from mild abdominal discomfort, back pain, intermittent cramping, distention, nausea, vomiting, diarrhea, constipation, and a reducible hernia, to severe abdominal pain, fever, and an unreducible hernia, which can be signs of a life-threatening complication. (See 'Complications requiring surgical intervention' below.)

DIAGNOSIS — Diagnosis is based upon characteristic findings of a parastomal hernia on physical examination. After removal of the appliance, the patient is examined in the standing position and asked to perform the Valsalva maneuver. A hernia and the paracolostomy or paraileostomy tissue can be identified by digital exploration [15,29]. Diagnostic imaging to evaluate subclinical PSH in patients with a negative physical examination is unnecessary.

COMPLICATIONS REQUIRING SURGICAL INTERVENTION — There is a low rate of life threatening complications associated with parastomal hernia (PSH) [14,15,43,44]. Urgent or emergent surgical repair because of the risk of ischemic bowel is necessary for patients with a high grade obstruction resulting from strangulation or an unreducible hernia. (See "Overview of management of mechanical small bowel obstruction in adults".)

Patients with the following signs or symptoms can be repaired electively:

Increasing PSH size

Peristomal skin breakdown

Intermittent bowel obstructions

Stoma appliance dysfunction and leakage

Chronic back and/or abdominal pain related to the PSH

Psychological distress caused by any of the previous symptoms

Stoma dysfunction (see "Management of patients with a colostomy or ileostomy", section on 'Complications').

NONSURGICAL MANAGEMENT — Surgical repair is avoided in most patients with no or mild symptoms because of the high recurrence rates. While no randomized trial has been conducted, most patients with mild symptoms can be managed with an ostomy hernia belt [2,14].

These patients should be educated about signs and symptoms of obstruction, strangulation, and infarction of bowel and instructed to contact the surgeon's office promptly if these symptoms occur. Delays in diagnosis of ischemic bowel can be life-threatening and may result in severe electrolyte imbalance, sepsis, and death.

SURGICAL REPAIR — The techniques for repair of parastomal hernia (PSH) include:

Relocation of the stoma

Direct repair of the fascial defect

Repair using a prosthetic mesh

A multitude of different approaches has been reported; there is no ideal repair and all are associated with varying recurrence rates. Complicating the assessment and comparison of the success of the different repair techniques is that most can be performed using various standard surgical procedures, including a local open repair at the stoma site, laparotomy, or a laparoscopic approach (figure 3).

Repair using prosthetic mesh — The high local failure rate of direct fascial repair for incisional, inguinal, and parastomal hernias and the evidence for defects in collagen metabolism (see 'Risk factors' above) led to the development of local repairs with prosthetic mesh, which is the most common method of PSH repair (figure 4).

The overall success rate for a repair with mesh is relatively high compared with repair without mesh, although all of the reports are nonrandomized, include small patient numbers, use different techniques, and have variable follow-up. However, a mesh repair is still associated with a local failure rate of 4 to 30 percent [45-53]. Furthermore, complications such as contamination of the mesh and fistula formation, while very rare, can be devastating [49].

Direct fascial repair with mesh — In this technique, an incision is made in the abdominal wall well away from the stoma and a subcutaneous dissection along the rectus and oblique fascia is performed circumferentially around the stoma. The content of the hernia is reduced into the abdomen and abdominal wall defect is closed using a tension free mesh repair. While all of the series describing this technique are small, nonrandomized, and lack long-term follow-up, these reports describe low perioperative complication rates, but recurrence rates ranging from 0 to 20 percent. The use of closed suction drains overlying the mesh appears to reduce complications resulting from seroma collections [50]. However, the use of drains to minimize the risk associated with seroma formation needs to be balanced against the possible risk of mesh infection. (See "Wound infections following abdominal wall hernia repair: Epidemiology, pathogenesis, and prevention".)

The advantages of a direct fascial repair are: (1) that it avoids the need for a formal laparotomy and (2) it does not require relocation of the stoma. A disadvantage is that undermining the skin around the stoma risks ischemic injury to the skin, which can result in significant management problems with the stoma appliance. Furthermore, the risk of infection contaminating the mesh is higher than intraperitoneal placement of mesh.

Intraabdominal repair with mesh — By far the most common approach to PSH repair is an intra-abdominal repair with a prosthetic mesh. The mesh may be placed above the fascia (onlay technique) or below the fascia and muscular layers (preperitoneal or sublay technique) (figure 5) [26,47,50,54-65]. Insertion of mesh into the abdominal wall defect (inlay technique) has been abandoned because of high failure rates.

The technique for mesh repair is described in detail separately. (See "Overview of abdominal hernias", section on 'Mesh repair'.)

The onlay technique has the advantage of being technically a more straight forward repair and avoids a large intra-abdominal dissection. It is associated with a higher risk of contamination and sepsis than the sublay technique. The sublay technique has a higher risk of adhesions and intestinal obstruction [47,55]. Identifying the best suited material for the mesh and establishing the best site for the placement of the mesh are the main problems with this technique. Similar to the surgical experience with incisional hernia repairs, the sublay technique is associated with fewer recurrences because intra-abdominal pressure does not dislocate the mesh from the repair [66].

There are several variations on the technique to place the mesh. The common aspect of all of the approaches is the reduction of the hernia contents into the abdominal cavity and closure of the defect by securing a piece of mesh under the defect with wide overlap onto the normal abdominal wall. The loop of bowel forming the ostomy is either brought out directly through a defect in the mesh, the "key hole" technique, or around the mesh, similar to the extraperitoneal ostomy construction. The bowel loop exiting at the stoma site is secured to the lateral and anterior abdominal wall and then a large piece of mesh is attached to the anterior and lateral abdominal wall over this loop of bowel, excluding all other bowel loops from contacting or protruding through the abdominal wall at the trephine for the stoma.

Laparoscopic mesh repair — Reports of decreased patient morbidity and improved outcomes with laparoscopic tension-free mesh repair of ventral and incisional hernias have led surgeons to apply these techniques to the repair of PSH. The Sugarbaker technique and modifications thereof have been widely used in laparoscopic repairs since it avoids the need for making apertures in the mesh, which make laparoscopic placement more difficult [61,63]. Short-term results are promising (recurrence rate less than 2 percent) [26,67], but longer term results (more than 24 months) are not available (figure 2).

There is very little data to determine which patients with PSH are best treated via a laparoscopic approach or an open approach. Based upon the experience with midline incisional hernias, a laparoscopic approach is best offered in patient with a smaller (<8 to 12 cm) hernia. Laparoscopic repair is also best reserved for when the surgeon does not anticipate extensive intestinal adhesions or extensive anterior peritoneal wall scarring from prior surgery [68].

Biologic substitutes for prosthetic mesh — The most recent approach for PSH repair is use of biologic tissue instead of prosthetic mesh [49,69-72]. The theoretical advantage is that it avoids the placement of synthetic material near the bowel and near a highly contaminated site, the stoma; however, biologic materials can cost thousands of dollars per piece. A review of four retrospective studies that included 57 patients with a PSH repaired with a biologic graft found a recurrence rate of 16 percent and wound complication rate of 26 percent [73]. This is comparable to the failure rate of PSH repair using prosthetic mesh. (See 'Repair using prosthetic mesh' above.)

While the data are limited regarding the use of biologic tissue substitutes for PSH, it should be considered in patients who are at especially high risk for synthetic mesh complications, such as inflammatory bowel disease patients.

Relocation of the stoma — Historically, the most common approach to a symptomatic PSH was to relocate the stoma to another site on the abdominal wall. This approach is to be generally avoided because the construction of a new stoma at a new site is associated with the same high risk of hernia formation as the primary stoma operation [45,74]. The local recurrence rate is approximately 36 percent (range 0 to 76 percent) and complication rates are as high as 88 percent [44,45,53,74]. This wide range of recurrence and complication rates reflects the variations of the definition of a PSH, type of stoma, size of defect, indications for a repair, length of time of follow-up, and whether or not the PSH is symptomatic.

Direct repair of the fascial defect — To address the high recurrence rate with relocation of a stoma, surgeons performed direct repairs of the hernia similar to suture repairs of inguinal and incisional hernias. A direct fascial repair involves reducing the size of the hernia defect by reapproximating the fascial edges of the trephine with permanent sutures. A direct local repair involves a dissection of the fascia at the site of the stoma. This approach can be performed at the local site externally or via a laparotomy incision or laparoscopically.

This approach is also generally avoided because the physics of PSH and the nature of the defect are not amenable to this simplistic approach. Another problem with this repair is that it violates an important surgical tenet of successful tissue healing: no tension should be placed on the repair. Recurrence rates for a primary fascial repair are high, ranging from 30 to 76 percent [45,74,75].


A parastomal hernia (PSH) is a type of incisional hernia that occurs at the site of the stoma or immediately adjacent to the stoma. (See 'Introduction' above.)

The development of a PSH is an almost inevitable complication following the construction of an intestinal stoma. (See 'Incidence' above.)

Obesity defined as a waist circumference of >100 centimeters is associated with a high risk of PSH. (See 'Risk factors' above.)

We suggest using prosthetic mesh for construction of a permanent colostomy to reduce the risk of PSH formation (Grade 2B). (See 'Prevention' above.)

Most patients with a PSH are asymptomatic. Symptoms range from mild abdominal discomfort to life-threatening symptoms. Patients typically present with a bulge at the site of or adjacent to the intestinal stoma, with or without pain (picture 1). (See 'Clinical manifestations' above.)

Diagnosis is based on characteristic findings of a hernia on physical examination. (See 'Diagnosis' above.)

We suggest that most patients with a parastomal hernia be initially managed with nonsurgical conservative management, such as using an ostomy hernia belt (Grade 2C). (See 'Nonsurgical management' above.)

We recommend that patients with signs and symptoms of ischemic bowel undergo an urgent or emergent surgical repair. (Grade 1C). (See 'Complications requiring surgical intervention' above.)

We suggest using prosthetic mesh for the repair of the PSH (Grade 2B). The mesh can be inserted laparoscopically or via a laparotomy. (See 'Surgical repair' above.)

We suggest that the repair be performed laparoscopically in patients with a hernia less than 8 to 12 centimeters and when there is no pre-operative evidence of extensive intra-abdominal adhesions (Grade 2C). In patients not meeting these criteria, we suggest that the repair be performed via laparotomy. (Grade 2C). (See 'Surgical repair' above.)

Use of UpToDate is subject to the Subscription and License Agreement.


  1. de Ruiter P, Bijnen AB. Successful local repair of paracolostomy hernia with a newly developed prosthetic device. Int J Colorectal Dis 1992; 7:132.
  2. Goligher, J. Surgery of the Anus, Colon and Rectum, 5th ed, Balleire Tindall, London 1984.
  3. Whittaker M, Goligher JC. A comparison of the results of extraperitoneal and intraperitoneal techniques for construction of terminal iliac colostomies. Dis Colon Rectum 1976; 19:342.
  4. Cheung MT. Complications of an abdominal stoma: an analysis of 322 stomas. Aust N Z J Surg 1995; 65:808.
  5. Mäkelä JT, Turku PH, Laitinen ST. Analysis of late stomal complications following ostomy surgery. Ann Chir Gynaecol 1997; 86:305.
  6. Leenen LP, Kuypers JH. Some factors influencing the outcome of stoma surgery. Dis Colon Rectum 1989; 32:500.
  7. Arumugam PJ, Bevan L, Macdonald L, et al. A prospective audit of stomas--analysis of risk factors and complications and their management. Colorectal Dis 2003; 5:49.
  8. Leong AP, Londono-Schimmer EE, Phillips RK. Life-table analysis of stomal complications following ileostomy. Br J Surg 1994; 81:727.
  9. Porter JA, Salvati EP, Rubin RJ, Eisenstat TE. Complications of colostomies. Dis Colon Rectum 1989; 32:299.
  10. Harshaw DH Jr, Gardner B, Vives A, Sundaram KN. The effect of technical factors upon complications from abdominal perineal resections. Surg Gynecol Obstet 1974; 139:756.
  11. Marks CG, Ritchie JK. The complications of synchronous combined excision for adenocarcinoma of the rectum at St Mark's Hospital. Br J Surg 1975; 62:901.
  12. von Smitten K, Husa A, Kyllönen L. Long-term results of sigmoidostomy in patients with anorectal malignancy. Acta Chir Scand 1986; 152:211.
  13. Kronborg O, Kramhöft J, Backer O, Sprechler M. Late complications following operations for cancer of the rectum and anus. Dis Colon Rectum 1974; 17:750.
  14. Martin L, Foster G. Parastomal hernia. Ann R Coll Surg Engl 1996; 78:81.
  15. Carne PW, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg 2003; 90:784.
  16. Hotouras A, Murphy J, Power N, et al. 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.
  17. Devlin HB. Peristomal hernia. In: Operative Surgery Volume 1: Alimentary Tract and Abdominal Wall, 4th ed, Dudley H (Ed), Butterworths, London 1983. p.441.
  18. Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, et al. The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 2009; 11:173.
  19. Pearl RK. Parastomal hernias. World J Surg 1989; 13:569.
  20. Leslie D. The parastomal hernia. Surg Clin North Am 1984; 64:407.
  21. Rosin JD, Bonardi RA. Paracolostomy hernia repair with Marlex mesh: a new technique. Dis Colon Rectum 1977; 20:299.
  22. Bass EM, Del Pino A, Tan A, et al. Does preoperative stoma marking and education by the enterostomal therapist affect outcome? Dis Colon Rectum 1997; 40:440.
  23. De Raet J, Delvaux G, Haentjens P, Van Nieuwenhove Y. Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 2008; 51:1806.
  24. Colwell JC. Stomal and peristomal complications. In: Fecal & Urinary Diversions: Management Principles, Goldberg MT, Colwell JC, Carmel JE (Eds), Mosby, St. Louis 2004. p.308.
  25. Trunbull GB. Parastomal hernias. Ostomy Wound Manage 2003; 49:15.
  26. Hansson BM, de Hingh IH, Bleichrodt RP. Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients. Surg Endosc 2007; 21:989.
  27. Junge K, Klinge U, Rosch R, et al. Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg 2004; 389:17.
  28. Rosch R, Junge K, Knops M, et al. Analysis of collagen-interacting proteins in patients with incisional hernias. Langenbecks Arch Surg 2003; 387:427.
  29. Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, et al. Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 2009; 249:583.
  30. Helgstrand F, Gögenur I, Rosenberg J. Prevention of parastomal hernia by the placement of a mesh at the primary operation. Hernia 2008; 12:577.
  31. Jänes A, Cengiz Y, Israelsson LA. Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 2009; 33:118.
  32. Vijayasekar C, Marimuthu K, Jadhav V, Mathew G. Parastomal hernia: Is prevention better than cure? Use of preperitoneal polypropylene mesh at the time of stoma formation. Tech Coloproctol 2008; 12:309.
  33. Jänes A, Cengiz Y, Israelsson LA. Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 2004; 91:280.
  34. Israelsson LA. Preventing and treating parastomal hernia. World J Surg 2005; 29:1086.
  35. Marimuthu K, Vijayasekar C, Ghosh D, Mathew G. Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study. Colorectal Dis 2006; 8:672.
  36. Gögenur I, Mortensen J, Harvald T, et al. Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation. Dis Colon Rectum 2006; 49:1131.
  37. Geisler DJ, Reilly JC, Vaughan SG, et al. Safety and outcome of use of nonabsorbable mesh for repair of fascial defects in the presence of open bowel. Dis Colon Rectum 2003; 46:1118.
  38. Hauters P, Cardin JL, Lepere M, et al. Prevention of parastomal hernia by intraperitoneal onlay mesh reinforcement at the time of stoma formation. Hernia 2012; 16:655.
  39. López-Cano M, Lozoya-Trujillo R, Quiroga S, et al. Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia 2012; 16:661.
  40. Ventham NT, Brady RR, Stewart RG, et al. Prophylactic mesh placement of permanent stomas at index operation for colorectal cancer. Ann R Coll Surg Engl 2012; 94:569.
  41. Wijeyekoon SP, Gurusamy K, El-Gendy K, Chan CL. 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.
  42. Lee L, Saleem A, Landry T, et al. Cost effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing permanent colostomy for rectal cancer. J Am Coll Surg 2014; 218:82.
  43. Sjödahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma. Br J Surg 1988; 75:339.
  44. Harold, KL. Laparoscopic parastomal hernia repair. In: Challenging Hernias PostGraduate Course. SAGES Annual Meeting. Philadelphia, PA, April 2008. p. 43.
  45. Rubin MS, Schoetz DJ Jr, Matthews JB. Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 1994; 129:413.
  46. Franks ME, Hrebinko RL Jr. Technique of parastomal hernia repair using synthetic mesh. Urology 2001; 57:551.
  47. Byers JM, Steinberg JB, Postier RG. Repair of parastomal hernias using polypropylene mesh. Arch Surg 1992; 127:1246.
  48. Morris-Stiff G, Hughes LE. The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl 1998; 80:184.
  49. Aldridge AJ, Simson JN. Erosion and perforation of colon by synthetic mesh in a recurrent paracolostomy hernia. Hernia 2001; 5:110.
  50. Kasperk R, Klinge U, Schumpelick V. The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg 2000; 179:186.
  51. Schumpelick V, Klinge U, Welty G, Klosterhalfen B. [Meshes within the abdominal wall]. Chirurg 1999; 70:876.
  52. Steele SR, Lee P, Martin MJ, et al. Is parastomal hernia repair with polypropylene mesh safe? Am J Surg 2003; 185:436.
  53. Tekkis PP, Kocher HM, Payne JG. Parastomal hernia repair: modified thorlakson technique, reinforced by polypropylene mesh. Dis Colon Rectum 1999; 42:1505.
  54. Stelzner S, Hellmich G, Ludwig K. Repair of paracolostomy hernias with a prosthetic mesh in the intraperitoneal onlay position: modified Sugarbaker technique. Dis Colon Rectum 2004; 47:185.
  55. Sugarbaker PH. Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann Surg 1985; 201:344.
  56. van Sprundel TC, Gerritsen van der Hoop A. Modified technique for parastomal hernia repair in patients with intractable stoma-care problems. Colorectal Dis 2005; 7:445.
  57. Guzmán-Valdivia G, Guerrero TS, Laurrabaquio HV. Parastomal hernia-repair using mesh and an open technique. World J Surg 2008; 32:465.
  58. Baig MK, Larach JA, Chang S, et al. Outcome of parastomal hernia repair with and without midline laparotomy. Tech Coloproctol 2006; 10:282.
  59. LeBlanc KA, Bellanger DE. Laparoscopic repair of paraostomy hernias: early results. J Am Coll Surg 2002; 194:232.
  60. Virzí G, Scaravilli F, Ragazzi S, Piazza D. Laparoscopic paracolostomy hernia mesh repair. Surg Laparosc Endosc Percutan Tech 2007; 17:548.
  61. Berger D, Bientzle M. Laparoscopic repair of parastomal hernias: a single surgeon's experience in 66 patients. Dis Colon Rectum 2007; 50:1668.
  62. Jani K, Palanivelu C, Parthasarathi R, Madhankumar MV. Laparoscopic repair of a paracolostomy hernia: secure reinforced closure of the defect prevents recurrence. J Laparoendosc Adv Surg Tech A 2007; 17:216.
  63. Mancini GJ, McClusky DA 3rd, Khaitan L, et al. Laparoscopic parastomal hernia repair using a nonslit mesh technique. Surg Endosc 2007; 21:1487.
  64. Voitk A. Simple technique for laparoscopic paracolostomy hernia repair. Dis Colon Rectum 2000; 43:1451.
  65. Muysoms EE, Hauters PJ, Van Nieuwenhove Y, et al. Laparoscopic repair of parastomal hernias: a multi-centre retrospective review and shift in technique. Acta Chir Belg 2008; 108:400.
  66. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg 2002; 89:534.
  67. Berger D, Bientzle M. Polyvinylidene fluoride: a suitable mesh material for laparoscopic incisional and parastomal hernia repair! A prospective, observational study with 344 patients. Hernia 2009; 13:167.
  68. Rosen MJ, Fatima J, Sarr MG. Repair of abdominal wall hernias with restoration of abdominal wall function. J Gastrointest Surg 2010; 14:175.
  69. Kish KJ, Buinewicz BR, Morris JB. Acellular dermal matrix (AlloDerm): new material in the repair of stoma site hernias. Am Surg 2005; 71:1047.
  70. Greenstein AJ, Aldoroty RA. Parastomal hernia repair using cross-linked porcine dermis: report of a case. Surg Today 2008; 38:1048.
  71. Lo Menzo E, Martinez JM, Spector SA, et al. Use of biologic mesh for a complicated paracolostomy hernia. Am J Surg 2008; 196:715.
  72. Taner T, Cima RR, Larson DW, et al. The use of human acellular dermal matrix for parastomal hernia repair in patients with inflammatory bowel disease: a novel technique to repair fascial defects. Dis Colon Rectum 2009; 52:349.
  73. Slater NJ, Hansson BM, Buyne OR, et al. Repair of parastomal hernias with biologic grafts: a systematic review. J Gastrointest Surg 2011; 15:1252.
  74. Cheung MT, Chia NH, Chiu WY. Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 2001; 44:266.
  75. Horgan K, Hughes LE. Para-ileostomy hernia: failure of a local repair technique. Br J Surg 1986; 73:439.
Topic 3691 Version 11.0

All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.