- Design
- Systematic review and meta-analysis (1 RCT, 5 observational studies)
- Population
- 1,480 patients with a permanent stoma after open or laparoscopic resection
- Primary outcome
- Incidence of parastomal hernia
- Effect
- Clinical RR 1.89 (1.39-2.58); radiological RR 1.70 (0.89-3.28)
A systematic review in Surgical Endoscopy (15 October 2026) pooled six studies - one randomised trial and five observational - of 1,480 patients with a permanent ileostomy or colostomy after open (731) or laparoscopic (749) resection, followed for more than a year.
Clinically diagnosed parastomal hernia was more common after laparoscopic surgery (RR 1.89, 95% CI 1.39-2.58). Radiologically assessed hernias showed the same direction, but the interval crossed 1.0 (RR 1.70, 0.89-3.28). The authors rated certainty very low, and noted that subcutaneous prolapse is rarely recorded as a separate entity.
One plausible reason is that the stoma trephine is often made or enlarged for specimen extraction in laparoscopic surgery. This does not argue against laparoscopy, whose benefits are well established, but it does argue for attention to trephine size and site, and for counselling patients about a risk that may be higher than assumed.
- Keep the stoma trephine no larger than needed, and avoid using it for specimen extraction where practical
- Counsel patients having laparoscopic resection with a permanent stoma about parastomal hernia risk
- Examine for parastomal hernia at each follow-up, standing and with cough
- Record subcutaneous prolapse separately from true parastomal hernia
Why it matters
A long-term complication may be a hidden cost of the minimally invasive approach to stoma-forming resection.
Don't overread it
Very low certainty evidence, mostly observational - not a reason to choose open surgery.
The statistics, in plain English
An RR of 1.89 means clinical hernia was about twice as common. The radiological result points the same way but its interval includes 1.0, so it alone could be chance. With five of six studies observational, sicker or different patients may have had open surgery.
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