Ramli Raziqah, Ng Zi Qin, Diab Jason, Gilmore Andrew
Department of Colorectal Surgery, Liverpool Hospital, Liverpool, NSW, Australia.
School of Medicine, University of New South Wales, Sydney, NSW, Australia.
J Abdom Wall Surg. 2024 Nov 28;3:13364. doi: 10.3389/jaws.2024.13364. eCollection 2024.
The acute presentation of parastomal hernia (PSH) can range from exacerbation of pain to life-threatening incarceration. Managing the acute PSH is challenging, particularly in the presence of concomitant midline incisional hernia. Most literature focuses on the outcomes of elective PSH repair. There is a paucity of literature on optimal management approaches to emergency PSH presentations. We aim to evaluate the outcomes of management of acute PSH presentations at a large acute tertiary hospital over a 10-year-period.
A retrospective analysis performed from May 2013 - May 2023 for all acute parastomal hernia presentations. The data collated included: demographics, index operation/pathology, duration of the stoma, clinical presentation, laboratory and imaging results and management outcomes (non-operative vs. operative intervention).
Twenty-two admissions of acute PSH over the study period with the median age of 77 years, and 14 males. The median Charlson comorbidity score was 5. Most patients had stoma formation due to malignancy (12) with most end-colostomy (10). 11 patients had previous PSH repairs. 13 patients underwent operative intervention on index presentation via a combination of approaches. 4 required small bowel resection and 4 had resection of stoma; 4 had relocation of the stoma. There was one postoperative death due to sepsis related multi-organ failure. There were five recurrences of PSH on follow-up. Of the nine patients managed non-operatively, seven subsequently had elective reconstruction.
Acute PSH presentation usually requires operative intervention with considerable recurrence rates. The approach to the PSH repair, in the acute setting, needs to be individualised. Further study is required to assist with the development of guidelines for managing this difficult problem.
造口旁疝（PSH）的急性表现范围从疼痛加剧到危及生命的嵌顿。处理急性PSH具有挑战性，尤其是在合并中线切口疝的情况下。大多数文献关注择期PSH修复的结果。关于紧急PSH表现的最佳管理方法的文献较少。我们旨在评估一家大型急性三级医院在10年期间急性PSH表现的管理结果。
对2013年5月至2023年5月期间所有急性造口旁疝表现进行回顾性分析。整理的数据包括：人口统计学、首次手术/病理、造口持续时间、临床表现、实验室和影像学结果以及管理结果（非手术与手术干预）。
在研究期间，有22例急性PSH入院患者，中位年龄为77岁，男性14例。查尔森合并症评分中位数为5。大多数患者因恶性肿瘤形成造口（12例），大多数为末端结肠造口（10例）。11例患者曾接受过PSH修复。13例患者在首次就诊时通过多种方法进行了手术干预。4例需要小肠切除，4例进行了造口切除；4例进行了造口重新定位。有1例患者因脓毒症相关的多器官衰竭术后死亡。随访中有5例PSH复发。在9例非手术治疗的患者中，7例随后进行了择期重建。
急性PSH表现通常需要手术干预，复发率较高。在急性情况下，PSH修复的方法需要个体化。需要进一步研究以协助制定管理这一难题的指南。
